title: Balloon-occluded retrograde transvenous obliteration for gastric varices via the intercostal vein.
abstract: Gastric varices are usually associated with a gastro-renal (G-R) shunt. However, the gastric varices described in this case report were not associated with a G-R shunt. The inflow vessel was the posterior gastric vein and the outflow vessels were the narrow inferior phrenic vein and the dilated cardio-phrenic vein. First, percutaneous transhepatic obliteration of the posterior gastric vein was performed, but the gastric varices remained patent. Then, micro-balloon catheterization of the subphrenic vein was carried out via the jugular vein, pericardial vein and cardio-phrenic vein, however, micro-balloon-occluded inferior phrenic venography followed by micro-coil embolization of the cardio-phrenic vein revealed no delineation of gastric varices resulting in no further treatment. Thereafter, as a gastro-subphrenic-intercostal vein shunt developed, a micro-balloon catheter was advanced to the gastric varices via the intercostal vein and balloon-occluded retrograde transvenous obliteration (BRTO) was performed resulting in the eradication of gastric varices. BRTO for gastric varices via the intercostal vein has not previously been documented.
authors.affiliation: Hiroki Minamiguchi, Nobuyuki Kawai, Morio Sato, Akira Ikoma, Munehisa Sawa, Tetsuo Sonomura, Shinya Sahara, Kouhei Nakata, Isao Takasaka, Motoki Nakai, Department of Radiology, Wakayama Medical University 811-1 Kimiidera, Wakayama Shi, Wakayama 641-8510, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Minamiguchi
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kawai
authors.forename: Morio
authors.initials: M
authors.lastname: Sato
authors.forename: Akira
authors.initials: A
authors.lastname: Ikoma
authors.forename: Munehisa
authors.initials: M
authors.lastname: Sawa
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Sonomura
authors.forename: Shinya
authors.initials: S
authors.lastname: Sahara
authors.forename: Kouhei
authors.initials: K
authors.lastname: Nakata
authors.forename: Isao
authors.initials: I
authors.lastname: Takasaka
authors.forename: Motoki
authors.initials: M
authors.lastname: Nakai