title: Vascular Plug Assisted Retrograde Transvenous Obliteration (PARTO) for Gastric Varix Bleeding Patients in the Emergent Clinical Setting.
abstract: OBJECTIVE
  To evaluate the technical feasibility and safety of vascular plug assisted retrograde transvenous obliteration (PARTO) for bleeding gastric varix performed in the emergent clinical setting and describe the mid-term clinical results.
  
  
  METHODS
  From April 2012 to January 2015, emergent PARTO was tried in total 9 patients presented with active gastric varix bleeding. After initial insufficient or failure of endoscopic approach, they underwent PARTO in the emergent clinical setting. Gelatin sponge embolization of both gastrorenal (GR) shunt and gastric varix was performed after retrograde transvenous placement of a vascular plug in GR shunt. Coil assisted RTO (CARTO) was performed in one patient who had challenging GR shunt anatomy for vascular plug placement. Additional embolic materials, such as microcoils and NBCA glue-lipiodol mixture, were required in three patients to enhance complete occlusion of GR shunt or obliteration of competitive collateral vessels. Clinical success was defined as no variceal rebleeding and disappearance of gastric varix.
  
  
  RESULTS
  All technical and clinical success-i.e., complete GR shunt occlusion and offending gastric varix embolization with immediate bleeding control-was achieved in all 9 patients. There was no procedure-related complication. All cases showed successful clinical outcome during mean follow up of 17 months (12-32 months), evidenced by imaging studies, endoscopy and clinical data. In 4 patients, mild worsening of esophageal varices or transient ascites was noted as portal hypertensive related change.
  
  
  CONCLUSIONS
  Emergent PARTO is technically feasible and safe, with acceptable mid-term clinical results, in treating active gastric varix bleeding.
authors.affiliation: Department of Vascular and Interventional Radiology, NHIS Ilsan Hospital, Goyang, Korea. azide2@naver.com.
authors.forename: Taehwan
authors.initials: T
authors.lastname: Kim
authors.affiliation: Department of Vascular and Interventional Radiology, NHIS Ilsan Hospital, Goyang, Korea.
authors.forename: Heechul
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, NHIS Ilsan Hospital, Goyang, Korea.
authors.forename: Chun Kyon
authors.initials: CK
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, NHIS Ilsan Hospital, Goyang, Korea.
authors.forename: Gun Bea
authors.initials: GB
authors.lastname: Kim
mesh_terms: D000368:Aged; D001201:Ascites / Q000150:complications; D021721:Balloon Occlusion; D004621:Embolization, Therapeutic; D004632:Emergency Medical Services; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: BRTO; Liver cirrhosis; PARTO; gastric varix; portal hypertension