Interventional Radiology: Balloon-Occluded Retrograde Transvenous Obliteration
Balloon-occluded retrograde transvenous obliteration (B-RTO) is a transcatheter treatment for gastric varices that are difficult to treat by endoscopic injection sclerotherapy. A balloon catheter is wedged into the main drainage vein of the gastric varices, such as gastrorenal shunt, and sclerosing agent (ethanolamine oleate with contrast media) is retrogradely injected into the gastric varices under balloon occlusion of the drainage vein. More than 5 hours of bed rest is recommended until the hard thrombus is formed in the varices. Many collateral veins appear after balloon occlusion, and understanding of the hemodynamics of the portal system is important. The success rate of thrombosis of gastric varices is high and the rebleeding rate is low. After B-RTO hepatic function reserve improved in about half of the patients due to restoration of the hepatopetal portal flow. Recently plug-assisted retrograde transvenous obliteration (PARTO) has been developed, in which a vascular plug is used instead of a balloon catheter.
KeywordsGastric varices Gastrorenal shunt Hepatic encephalopathy Ethanolamine oleate Vascular plug
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