Balloon retrograde

Double wire Anchoring balloon Retrograde via collaterals Re-entry techniques... 

Possible complications include massive myocardial infarction due to retrograde flow around the occlusion balloon, complete heart block, ventricular fibrillation, stroke, dissection of the left anterior descending artery, and right coronary artery thrombosis. Though high grade atrioventricular blockage occurs relatively frequently, procedural mortality rate is low (0-4%) and severe complications are rare and often avoidable (7-10). 

Since the first steps in transluminal balloon dilation of mitral valves in 1982 (24) numerous techniques have been described. One method is to access the left atrium with a transseptal puncture from the venous side (antegrade). Another way is to advance the catheter via the aorta into the left ventricle and perform the valvulotomy from the arterial side (retrograde). The use of two dilation balloons introduced via the transseptal approach is a common technique described by Bonhoeffer using a monorail-type system over a single guidewire (25). 

Approaching the aortic valve with a catheter can be achieved via the venous (antegrade, transseptal) or the arterial routes (retrograde) (37,38). The delivery assembly is positioned within the diseased native valve. Before expansion of the valve mounted balloon rapid pacing (>200 beats/min) is performed to lower stroke volume during the implantation sequence. The balloon is inflated fixing the stented valve to the implantation site. Immediately after balloon deflation... 

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... 

Figure 5. A, Schematic of a Largerdortf perfused rat heart model. Retrograde perfusion is established through the aorta. Perfusate oxygenated with 95% O, and 5% CO, is circulated by a peristaltic pump and the flow can be adjusted. Left ventricular pressure is monitored Ihrough a balloon which is inserted into the empty left ventricle. Heart rhythm is controlled by pacing.

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... 

Takahashi K, Yamada T et al. (2001) Selective balloon-occluded retrograde sclerosis of gastric varices using a coaxial microcatheter system. AJR Am J Roentgenol 177 1091-1093... 

In some cases, identification of a lateral venons branch in which to place a left ventricular lead is not immediately visualized. Most commonly, this is because either an insufficient mount of dye retrogradely filled aU venous branches due to poor balloon occlusion, the balloon itself occlnded the proximal aspect of an eligible lateral vessel, or another more proximal branch was not visualized due to distal balloon or angiographic catheter placement. In these cases, withdrawing the sheath to the ostium of the coronary sinns and performing a hand injection at this location will often identify a vessel snpplying the lateral wall when none was previously seen. 

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. 

Retrograde urethrography is rarely indicated, and retrograde or suprapubic VCU should be preferred in most patients. Such an examination is usually performed to rule out a ruptured urethra in an adolescent. A Foley catheter is inserted in the distal urethra. The balloon is then inflated in the fossa navicularis, and the urethra is slowly and retro-gradely injected. Lateral and oblique pictures are taken. In most instances, the posterior urethra is not opacified. This should not be considered abnormal. 

The rectum frequently fails to opacify after the injection of contrast material into the cloaca. In patients who have already had a colostomy, contrast material can be directly injected into the distal limb of the colostomy prior to retrograde cloacal injection. This technique regularly demonstrates the level of rectal occlusion and the presence of conunu-nication between other pelvic structures, making further cloacal injections unnecessary (Fig. 7.23). Most commonly, a balloon catheter is used to inject contrast material under moderate pressure to dem-... 

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