Retrograde Transvenous Obliteration of Gastric Varices

Background: We previously reported the techniques and usefulness of simultaneous combined balloon-occluded retrograde transvenous obliteration (B-RTO) and partial splenic embolization (PSE), based on the hypothesis that concomitant PSE can diminish the increase in portal venous pressure after B-RTO. Objective: After experiencing more cases and performing longer-term follow-up, we re-evaluated the efficacy of simultaneous combined B-RTO and PSE for gastric fundal varices (GVs). Methods: We performed B-RTO in 36 consecutive patients treated for GVs from 2005 to 2013. Twenty-three patients underwent simultaneous combined B-RTO and PSE (Group 1) and 13 underwent B-RTO monotherapy (Group 2). The outcomes were retrospectively evaluated. Results: There were no significant differences in baseline characteristics between the two groups except that the splenic volumes were larger in Group 1 than 2. B-RTO was technically successful in 21 of 23 patients (91.3%) in Group 1 and in 12 of 13 patients (92.3%) in Group 2. In all patients with ruptured GVs (six in Group 1 and five in Group 2), complete hemostasis was obtained by B-RTO. Exacerbation of esophageal varices was significantly less frequent in Group 1 than 2 (p ¼ 0.0017). Conclusion: Concomitant PSE with B-RTO may contribute to prevention of the exacerbation of esophageal varices after B-RTO.

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“…[1][2][3][4] Application of prophylactic interventions such as B-RTO is controversial. GV rupture is a fatal condition.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] The reported rate of bleeding in patients with GVs is 3% to 30%. [4][5][6][7] Rupture of GVs is associated with a higher mortality rate (45%-50%) than rupture of EVs because patients with GVs have more blood flow through the gastrorenal shunt (GRS).…”

Section: Introductionmentioning

confidence: 99%

Simultaneous combined balloon‐occluded retrograde transvenous obliteration and partial splenic embolization for gastric fundal varices

et al. 2016

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“…Apart from EO-related complications, such as renal tubular disturbances, cardiogenic shock, pulmonary edema, and disseminated intravascular coagulation [44][45][46], early complications after embolization of portosystemic shunt include puncture site hematoma, intra-abdominal bleeding, infection, fever, hepatic failure, migration of embolic agents (nontarget embolization), and contrast-induced nephropathy [24,32,35]. Late complications include aggravation of gastroesophageal varices, rupture of gastroesophageal varices, portal hypertensive gastropathy, an increase in as- C. Good retention of 5% EO was seen after embolization of the intercostal vein, and then the splenorenal shunt was completely thrombosed.…”

Section: Safetymentioning

confidence: 99%

Efficacy and Safety of Transcatheter Embolization for Hepatic Encephalopathy Caused by Spontaneous Portosystemic Shunts

Takenaga

Aizawa

2017

Interventional Radiology

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Hepatic encephalopathy (HE) is a syndrome that occurs in patients with severe liver dysfunction or a portosystemic shunt. In patients with refractory HE caused by a portosystemic shunt, interventional closure of the shunt vessel is essential. Currently, transcatheter embolization is recognized as a less invasive and highly effective procedure, and it is considered as a first-choice method for the occlusion of shunt vessels. In this review, we discuss the role of a portosystemic shunt in the development of HE and describe the procedure and significance of transcatheter embolization of a portosystemic shunt.

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“…The BRTO technique has been described in many reports (4)(5)(6)(7) and has shown considerable effectiveness with low rebleeding rates (4)(5)(6)(7)(8)(9)(10). Its advantages over TIPS include less invasiveness and greater performance ease in patients with poor hepatic reserve, encephalopathy, or refractory ascites (2,7,8).…”

Section: Balloon-occluded Retrograde Transvenous Obliteration (Brto)mentioning

confidence: 99%

Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Management of Gastric Varices: Comparative Effectiveness between Gelatin Sponge Embolization and Permanent Sclerosant

Lee

Park

et al. 2016

J Korean Soc Radiol

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Purpose:To evaluate the short-term outcome of plug-assisted retrograde transvenous obliteration (PARTO) using vascular plugs and gelatin sponges in comparison with balloon-occluded retrograde transvenous obliteration (BRTO) for the management of gastric varices. Materials and Methods: From January 2005 to October 2014, 171 patients were referred for management of gastric varices, of which, 52 patients with hemodynamically stable gastric varices (48 recent bleeding; 4 primary prophylaxes) were evaluated. Of these, 38 received BRTO (men/women 23/15; mean age 61.3; Child-Pugh classes A/B/C = 11/25/2) and 14 underwent PARTO (men/women 11/3; mean age 63.4; ChildPugh classes A/B/C = 9/4/1). The technical success rate, complications, variceal changes, liver function, and exacerbation of ascites/pleural effusion were compared between the 2 groups within 3 months after the procedure. Results: The technical success rates were 92.1% in the BRTO and 100% in the PARTO group. Procedure-related early complications occurred in the BRTO group alone (8%, n = 3). Among patients with technical success, follow-up CT at 1 month was available for 98% (n = 48/49). Complete thrombosis of gastric varices was achieved in 97.1% in the BRTO and 100% in the PARTO group. Worsening of esophageal varices was observed in 24% of the BRTO group alone (n = 8). The albumin level increased significantly in both groups and aspartate aminotransferase/alanine aminotransferase level improved significantly in the PARTO group (p < 0.05). Exacerbation of ascites/pleural effusion was observed in both groups (35.2% vs. 21.4%, both p > 0.05). Conclusion: PARTO appears to be equivalent to BRTO for short-term management of gastric varices.

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Retrograde Transvenous Obliteration of Gastric Varices

Abstract: Balloon-occluded retrograde transvenous obliteration is a feasible alternative to a transjugular intrahepatic portosystemic shunt for patients with large gastrorenal shunts or hepatic encephalopathy (or both).

Cited by 275 publications

References 21 publications

Simultaneous combined balloon‐occluded retrograde transvenous obliteration and partial splenic embolization for gastric fundal varices

Simultaneous combined balloon‐occluded retrograde transvenous obliteration and partial splenic embolization for gastric fundal varices

Efficacy and Safety of Transcatheter Embolization for Hepatic Encephalopathy Caused by Spontaneous Portosystemic Shunts

Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Management of Gastric Varices: Comparative Effectiveness between Gelatin Sponge Embolization and Permanent Sclerosant

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