Plug-assisted retrograde transvenous obliteration via gastrocaval shunt for the gastric variceal bleeding

Abstract

Rationale: Most gastric varices at the fundus drain into the left renal vein via the gastrorenal shunt (80–85% of cases) or the inferior vena cava via the gastrocaval shunt (10–15%). Therefore, plug-assisted retrograde transvenous obliteration (PARTO) is usually performed via a gastrorenal shunt. Here, we report a case of gastric varix treated with PARTO via a gastrocaval shunt. Patient concerns: A 46-year-old woman with hepatitis B virus and liver cirrhosis visited the emergency room in our hospital with the main symptom of hematemesis and hematochezia. Diagnoses: Endoscopy and computed tomography (CT) revealed a gastric varix and thrombotic-occluded transjugular intrahepatic portosystemic shunt (TIPS) stent. Interventions: The patient underwent PARTO via a gastrocaval shunt to manage gastric variceal bleeding after failed TIPS revision. Outcomes: On CT, the gastric varix completely disappeared. The patient did not experience any additional bleeding events. Lessons: PARTO via a gastrocaval shunt is safe and effective.

Plug-assisted retrograde transvenous obliteration for the treatment of gastric variceal bleeding in absence of gastrorenal or gastrocaval shunt: A case report

“…[10][11][12][13] PARTO and BRTO are methods of gastric varix management that use a retrograde approach via the draining vein connected to the systemic vein. Jang et al [7] described a case in which PARTO was performed through a gastrocaval shunt in a patient who had gastric variceal bleeding without a gastrorenal shunt. Furthermore, in a study by Araki et al, [14] BRTO was performed via other pathways in patients with gastric varices without gastrorenal shunts.…”

“…Recently, Gwon et al introduced the plug-assisted retrograde transvenous obliteration (PARTO) technique, which uses a vascular plug and retrograde injection of gelatin sponge particles to induce thrombosis of the gastric varix and gastrorenal/gastrocaval shunt. [ 6 , 7 ] This method has gained popularity as an alternative treatment method for gastric varices.…”

Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Duodenal Variceal Bleeding - A Case Report and Literature Review

“…Cases of successful embolization through BRTO for duodenal variceal bleeding have been reported, 3 along with cases of PARTO for gastric variceal bledding. 4 On the other hand, reports of successful PARTO for duodenal variceal bleeding are exceptionally rare. This paper presents a case where PARTO was used to treat duodenal variceal bleeding, a rare anatomical variation of venous drainage.…”