Balloon-occluded retrograde transvenous obliteration

Kitamoto, M., Imamura, M., Kamada, K., Aikata, M., Kawakanu, Y., Matsumoto, A., Kurihara, Y., Kono, H., Shirakawa, H., Nakanishi, T., Ito, K., Chayama, K. Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage. Amer. J. Gastroenterol. 2002 178 1167-1174... 

Balloon-occluded Retrograde Transvenous Obliteration of Gastric Varices in Portal Hypertension... 

The major aims of interventional procedures for portal hypertension are prophylactic and emergent treatment of variceal bleeding, control of hepatic encephalopathy, and treatment of refractory ascites. Hypersplenism associated with hematological disorder is an additional clinical problem in patients with portal hypertension. At present, the main primary embolotherapies available for portal hypertension are balloon-occluded retrograde transvenous obliteration (BRTO) and partial splenic embolization (PSE). In Japan, BRTO has recently been applied for gastric varices instead of either endoscopic treatment or transhepatic intrahepatic portosystemic shunt (TIPS) procedure, and numerous studies have reported that this method has an excellent success rate. Its efficacy for control of hepatic encephalopathy has also been demonstrated. 

Table 8.1. Cookbook Materials for balloon-occluded retrograde transvenous obliteration...

Fig.8.3a-c. Balloon-occluded retrograde transvenous obliteration for duodenal varices, a A varicogram obtained by-injection of sclerosant through a microcatheter advanced into the pancreaticoduodenal vein shows duodenal varices (arrowheads). A balloon catheter is inserted into the right ovarian vein (flrrow).b A contrast-enhanced CT obtained before BRTO shows duodenal varices (arrow), c A contrast-enhanced CT obtained 7 days after B-RTO shows thrombosis of the duodenal varices... 

Fukuda T, Hirota S et al. (2001) Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy. J Vase Interv Radiol 12 327-336... 

Kanagawa H, Mima S et al. (1996) Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration.) Gastroenterol Hepatol 11 51-58... 

Kato T, Uematsu T et al. (2001) Therapeutic effect of balloon-occluded retrograde transvenous obliteration of portal-systemic encephalopathy in patients with liver cirrhosis. Intern Med 40 688-691... 

Kitamoto M, Imamura M et al. (2002) Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage. AJR Am J Roentgenol 178 1167-1174... 

Koito K, Namieno T et al. (1996) Balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals. AJR Am J Roentgenol 167 1317-1320... 

Miyamoto Y, Oho K et al. (2003) Balloon-occluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension. J Gastroenterol Hepatol 18 934-942... 

Sonomura T, Horihata K et al. (2002) Ruptured duodenal varices successfully treated with balloon-occluded retrograde transvenous obliteration. AJR Am J Roentgenol 181 725-727... 

Another report describes the balloon-occluded retrograde transvenous obliteration, which is traditionally based on liquid sclerotherapy. However, overdose and systemic spillage of liquid sclerosant can cause severe complications, such as haemolysis that can lead to haemoglobinuria, allergy, acute respiratory distress S5mdrome and other disorders. 

In all patients, foam was observed in the target vessels at C-arm CT. The mean dose of polidocanol used for balloon-occluded retrograde transvenous obliteration was significantly smaller than the dose of contrast medimn used for venography. Haemoglobinuria was foimd in only one patient. Except in one instance of recanalisation, full variceal thrombosis was confirmed at contrast-enhanced CT 1 week after transvenous obliteration. In one patient, air migrated into the liver during transvenous obliteration, but it was spontaneously absorbed. 

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