title: The conventional balloon-occluded retrograde transvenous obliteration procedure: indications, contraindications, and technical applications.
abstract: Transvenous obliteration of gastric varices can be performed from the systemic venous side (draining veins or shunts) or from the portal venous side (portal afferent feeders). Balloon-occluded transvenous obliteration from the systemic veins is referred to as balloon-occluded retrograde transvenous obliteration (BRTO) and balloon-occluded transvenous obliteration from the portal veins is referred to as balloon-occluded antegrade (anterograde) transvenous obliteration (BATO). BRTO is the conventional balloon-occluded transvenous obliteration procedure and BATO is considered an alternative or adjunctive approach. This is because, from a technical standpoint, the least invasive choice of access or approach for balloon-occluded transvenous obliteration of gastric varices is the traditional or conventional transrenal route. The objective of BRTO or BATO or both is complete obliteration of the gastric varices with preservation of the anatomical hepatopetal flow of the splenoportal circulation. This article reviews the indications, contraindications, and technical considerations of the conventional BRTO procedure. The indications of concomitant portal venous modulators such as splenic embolization or the creation of a transjugular intrahepatic portosystemic shunt or both are also discussed.
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, University of Virginia Health System, Charlottesville, VA 22908, USA. wspikes@yahoo.com
authors.forename: Wael E A
authors.initials: WE
authors.lastname: Saad
authors.forename: Takashi
authors.initials: T
authors.lastname: Kitanosono
authors.forename: Jun
authors.initials: J
authors.lastname: Koizumi
authors.forename: Shozo
authors.initials: S
authors.lastname: Hirota
mesh_terms: D021721:Balloon Occlusion / Q000009:adverse effects / Q000379:methods*; D003097:Collateral Circulation; D004621:Embolization, Therapeutic; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology; D010690:Phlebography; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D015641:Radiography, Interventional; D012039:Regional Blood Flow; D015911:Sclerotherapy; D013152:Splanchnic Circulation; D016896:Treatment Outcome
keywords: balloon-occlusion; gastric varices; obliteration; phrenic vein; sclerosant; trans-TIPS; transhepatic; transvenous obliteration