title: Short- and long-term clinical outcome after balloon-occluded retrograde transvenous obliteration: is pretreatment portal flow direction a predictive factor?
abstract: OBJECTIVE
  To determine whether pretreatment portal flow direction can predict different clinical manifestations or prognosis after balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices.
  
  
  METHODS
  The subjects were 103 cirrhotic patients with medium- or large-grade gastric varices treated by B-RTO. Short- and long-term clinical outcomes were compared among patients with forward portal flow (F group) and those with reversed or to-and-fro portal flow (R group) on color Doppler sonography before B-RTO.
  
  
  RESULTS
  Deterioration of liver function reserve 1 year after B-RTO was more frequent in the R group (34.7 %) than in the F group (11.1 %, p = 0.0251). Thrombotic disorders within 1 year after B-RTO were also more frequent in the R group (20.7 %) than in the F group (2.7 %, p = 0.0079). There was no significant difference in cumulative survival rate of Child class A patients between the two groups. In Child class B or class C patients, however, the cumulative survival rate was poorer in the R group (68.7, 30.5, and 30.5 % at 1, 5, and 9 years, respectively) than in the F group (94.9, 58.8, and 37.8 % and 1, 5, and 9 years, respectively; p = 0.0097).
  
  
  CONCLUSIONS
  Hemodynamic assessment of portal flow direction is important before B-RTO, and care should be taken to manage thrombotic disorders in the perioperative period in patients with reversed portal flow after B-RTO. Another treatment option might be preferred for gastric varices in Child classes B and C patients with reversed portal flow instead of B-RTO, which may have a poor prognosis.
authors.affiliation: Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Kamezaki
authors.affiliation: Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. maru-cib@umin.ac.jp.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Maruyama
authors.affiliation: Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Shimada
authors.affiliation: Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Okugawa
authors.affiliation: Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
keywords: Balloon-occluded retrograde transvenous obliteration (B-RTO); Doppler ultrasound; Gastric varices; Portal hypertension