Successful Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Varices Using Foam Sclerosant Followed by Glue Embolization of Gastrorenal Shunt via the Brachial Vein Approach in a Severely Obese Patient

Abstract

Balloon-occluded retrograde transvenous obliteration is an effective treatment for gastric varices. In this report, we illustrate a consecutive treatment strategy via brachial vein approach and n-butyl cyanoacrylate (NBCA) packing of the gastrorenal shunt (GRS) after injecting sclerosing agent in a severely obese patient. The brachial vein approach reduced the burden on the patient, and the closure of the GRS using NBCA shortened the procedure time. These techniques may improve patient comfort as well as reduce medical costs and the risks of several complications.

Safety, Efficacy, and Outcomes of N-Butyl Cyanoacrylate Glue Injection through the Endoscopic or Radiologic Route for Variceal Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

“…Small collateral veins are generally embolized prior to sclerosing agent injection to prevent leakage of the sclerosing agent or varix recurrence [ 81 , 82 , 83 , 84 ]. Tsuruya et al reported a case where NBCA-Lipiodol ® were used for gastrorenal shunt embolization after injecting sclerosing agent in a severely obese patient, resulting in a shorter procedure time [ 85 ].…”

N-Butyl-cyanoacrylate-assisted retrograde transvenous obliteration (NARTO) for gastric varices

“…To lower the cost and shorten the procedure time, we injected n -butyl cyanoacrylate (nBCA) to embolize the GRS after sclerosant injection (case 1). Before now, the use of nBCA in BRTO was previously reported in a case report, in which it was injected after injecting a foam sclerosant into a GV via a brachial vein approach [7] . In this report, we describe three consecutive patients in whom GVs were treated by nBCA-assisted retrograde transvenous obliteration (NARTO), after a case (case 1) in whom nBCA was injected after coil placement.…”