Management of Gastric Varices Unsuccessfully Treated by Balloon-Occluded Retrograde Transvenous Obliteration: Long-Term Follow-Up and Outcomes
Figure 1
Schemas of percutaneous transhepatic obliteration and combined therapy. Percutaneous transhepatic obliteration (PTO): in the case of varices whose gastrorenal shunts were too underdeveloped for balloon occlusion, the PTO procedure was used. The intrahepatic portal vein is punctured from the right or left upper abdomen using a PTCD needle under ultrasonographic guidance. After an introducer sheath is inserted into the intrahepatic portal vein, a balloon catheter is inserted, and the catheter is advanced into the inflowing shunt vessel (mainly the left gastric vein), after which the balloon was inflated to occlude blood inflow (broad arrow). Combined therapy: the combined PTO and balloon-occluded retrograde transvenous obliteration (BRTO) procedure was used when the gastric varices had large shunt vessels (usually gastrorenal and left gastric vein shunts), which could not be successfully treated with either treatment alone. The narrow arrow indicates a balloon catheter placed in the gastro-renal shunt.
