plug assisted retrograde transvenous obliteration

high rate of technical success (range 77-100%) 2.portal/renal vein thrombosis - usually asymptomatic.altered respiratory function (presumably secondary to altered pulmonary perfusion).temporary worsening of ascites or hydrothorax.This significantly reduces procedure time and decreases the risk of balloon rupture. Modified techniques such as PARTO, CARTO, and BATO essentially follow the same procedure, except that shunt occlusion is permanently achieved by vascular plugging or coiling. sclerosant is injected upstream of the balloon into the gastric varices themselves, with the occlusive balloon remaining in place for 4-20 hours until abdominal radiograph shows stasis of sclerosant.significant efferent collateral vessels are embolized using coils, and/or gelfoam and sclerosant.Occlusive balloon is inflated to occlude the shunt, then contrast injected upstream of the occlusion (retrograde venography) to further evaluate variceal anatomy and identify major collateral vessels.the target shunt (typically gastro-renal shunt via left renal vein) catheterized using with selective catheter, e.g.a 6 to 12-French vascular sheath placed.systemic venous access obtained via femoral vein approach, alternatively via internal jugular vein approach.The classic BRTO procedure is as follows: afferent & efferent gastric variceal anatomy.CT imaging - ideally immediately preceding BRTO intervention.standard laboratory studies, including liver enzymes and coagulation panel.The techniques employed are typically adapted depending on specific portosystemic anatomy and operator experience/preference. balloon-occluded antegrade transvenous obliteration (BATO).coil-assisted retrograde transvenous obliteration (CARTO).vascular plug-assisted retrograde transvenous obliteration (PARTO).The classic BRTO procedure has been largely supplanted by modified techniques which involve shorter procedures times. prophylaxis against re-bleeding in the setting of primary endoscopic therapy.active haemorrhage, after failed endoscopic treatment.Nonetheless, modified BRTO techniques are gaining popularity in Western countries, particularly in the setting of failed endoscopic intervention and contraindication for TIPS 2,3. The technique is more popular in Asia, where it is a first-line treatment for gastric variceal hemorrhage 1.

Balloon-occluded retrograde transvenous obliteration (BRTO) is a technique used by interventional radiologists in the treatment of gastric varices, particularly those with prominent infra-diaphragmatic portosystemic venous shunts (e.g.

Plug assisted retrograde transvenous obliteration