Download PDF
Semin intervent Radiol 2011; 28(3): 283-287
DOI: 10.1055/s-0031-1284454
© Thieme Medical Publishers

The History and Evolution of Balloon-occluded Retrograde Transvenous Obliteration (BRTO): From the United States to Japan and Back

Wael E. A. Saad1
  • 1Division of Vascular Interventional Radiology, Department of Radiology, University of Virginia Health System, Charlottesville, Virginia
Further Information

Publication History

Publication Date:
15 August 2011 (online)

Also available at
    Permissions and Reprints

ABSTRACT

The concept of obliterating varices that complicate portal hypertension dates back to the 1970s, but its minimally invasive clinical utilization was probably lost with the advent of the transjugular intrahepatic portosystemic shunt (TIPS). The conception of retrograde obliteration of a gastrorenal shunt via the left renal vein was reported by Olson et al from the University of Indiana. However, the definition, development, technical perfection, and clinical implementation of the balloon-occluded retrograde transvenous obliteration (BRTO) occurred in Japan (by Kanagawa et al and others). The BRTO-procedure is currently undergoing a renaissance in the United States particularly for patients who are not TIPS candidates.

KEYWORDS

History - BRTO - transvenous obliteration - varices - TIPS

REFERENCES

  • 1 Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration.  J Gastroenterol Hepatol. 1996;  11 (1) 51-58
    CrossrefPubMedGoogle Scholar
  • 2 Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y. Transcatheter obliteration of gastric varices. Part 1. Anatomic classification.  Radiographics. 2003;  23 (4) 911-920
    CrossrefPubMedGoogle Scholar
  • 3 Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y. Transcatheter obliteration of gastric varices: Part 2. Strategy and techniques based on hemodynamic features.  Radiographics. 2003;  23 (4) 921-937 discussion 937
    CrossrefPubMedGoogle Scholar
  • 4 Ibukuro K, Sugihara T, Tanaka R et al.. Balloon-occluded retrograde transvenous obliteration (BRTO) for a direct shunt between the inferior mesenteric vein and the inferior vena cava in a patient with hepatic encephalopathy.  J Vasc Interv Radiol. 2007;  18 (1 Pt 1) 121-125
    CrossrefPubMedGoogle Scholar
  • 5 Yamagami T, Kato T, Hirota T, Yoshimatsu R, Matsumoto T, Nishimura T. Infusion of 50% glucose solution before injection of ethanolamine oleate during balloon-occluded retrograde transvenous obliteration.  Australas Radiol. 2007;  51 (4) 334-338
    CrossrefPubMedGoogle Scholar
  • 6 Kitamoto M, Imamura M, Kamada K et al.. Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage.  AJR Am J Roentgenol. 2002;  178 (5) 1167-1174
    CrossrefPubMedGoogle Scholar
  • 7 Ninoi T, Nakamura K, Kaminou T et al.. TIPS versus transcatheter sclerotherapy for gastric varices.  AJR Am J Roentgenol. 2004;  183 (2) 369-376
    CrossrefPubMedGoogle Scholar
  • 8 Ninoi T, Nishida N, Kaminou T et al.. Balloon-occluded retrograde transvenous obliteration of gastric varices with gastrorenal shunt: long-term follow-up in 78 patients.  AJR Am J Roentgenol. 2005;  184 (4) 1340-1346
    CrossrefPubMedGoogle Scholar
  • 9 Akahoshi T, Hashizume M, Tomikawa M et al.. Long-term results of balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding and risky gastric varices: a 10-year experience.  J Gastroenterol Hepatol. 2008;  23 (11) 1702-1709
    CrossrefPubMedGoogle Scholar
  • 10 Fukuda T, Hirota S, Sugimura K. Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy.  J Vasc Interv Radiol. 2001;  12 (3) 327-336
    CrossrefPubMedGoogle Scholar
  • 11 Sonomura T, Sato M, Kishi K et al.. Balloon-occluded retrograde transvenous obliteration for gastric varices: a feasibility study.  Cardiovasc Intervent Radiol. 1998;  21 (1) 27-30
    CrossrefPubMedGoogle Scholar
  • 12 Kiyosue H, Matsumoto S, Onishi R et al.. Balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices: therapeutic results and problems.  Nippon Igaku Hoshasen Gakkai Zasshi. 1999;  59 (1) 12-19
    PubMedGoogle Scholar
  • 13 Koito K, Namieno T, Nagakawa T, Morita K. Balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals.  AJR Am J Roentgenol. 1996;  167 (5) 1317-1320
    CrossrefPubMedGoogle Scholar
  • 14 Chikamori F, Kuniyoshi N, Kawashima T, Takase Y. Gastric varices with gastrorenal shunt: combined therapy using transjugular retrograde obliteration and partial splenic embolization.  AJR Am J Roentgenol. 2008;  191 (2) 555-559
    CrossrefPubMedGoogle Scholar
  • 15 Kumamoto M, Toyonaga A, Inoue H et al.. Long-term results of balloon-occluded retrograde transvenous obliteration for gastric fundal varices: hepatic deterioration links to portosystemic shunt syndrome.  J Gastroenterol Hepatol. 2010;  25 (6) 1129-1135
    CrossrefPubMedGoogle Scholar
  • 16 Chikamori F, Kuniyoshi N, Shibuya S, Takase Y. Transjugular retrograde obliteration for chronic portosystemic encephalopathy.  Abdom Imaging. 2000;  25 (6) 567-571
    CrossrefPubMedGoogle Scholar
  • 17 Chikamori F, Kuniyoshi N, Shibuya S, Takase Y. Combination treatment of transjugular retrograde obliteration and endoscopic embolization for portosystemic encephalopathy with esophageal varices.  Hepatogastroenterology. 2004;  51 (59) 1379-1381
    PubMedGoogle Scholar
  • 18 Chikamori F, Kuniyoshi N, Shibuya S, Takase Y. Eight years of experience with transjugular retrograde obliteration for gastric varices with gastrorenal shunts.  Surgery. 2001;  129 (4) 414-420
    CrossrefPubMedGoogle Scholar
  • 19 Miyamoto Y, Oho K, Kumamoto M, Toyonaga A, Sata M. Balloon-occluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension.  J Gastroenterol Hepatol. 2003;  18 (8) 934-942
    CrossrefPubMedGoogle Scholar
  • 20 Hirota S, Matsumoto S, Tomita M, Sako M, Kono M. Retrograde transvenous obliteration of gastric varices.  Radiology. 1999;  211 (2) 349-356
    CrossrefPubMedGoogle Scholar
  • 21 Sugimori K, Morimoto M, Shirato K et al.. Retrograde transvenous obliteration of gastric varices associated with large collateral veins or a large gastrorenal shunt.  J Vasc Interv Radiol. 2005;  16 (1) 113-118
    CrossrefPubMedGoogle Scholar
  • 22 Fukuda T, Hirota S, Matsumoto S et al.. Application of balloon-occluded retrograde transvenous obliteration to gastric varices complicating refractory ascites.  Cardiovasc Intervent Radiol. 2004;  27 (1) 64-67
    PubMedGoogle Scholar
  • 23 Shimoda R, Horiuchi K, Hagiwara S et al.. Short-term complications of retrograde transvenous obliteration of gastric varices in patients with portal hypertension: effects of obliteration of major portosystemic shunts.  Abdom Imaging. 2005;  30 (3) 306-313
    CrossrefPubMedGoogle Scholar
  • 24 Takuma Y, Nouso K, Makino Y, Saito S, Shiratori Y. Prophylactic balloon-occluded retrograde transvenous obliteration for gastric varices in compensated cirrhosis.  Clin Gastroenterol Hepatol. 2005;  3 (12) 1245-1252
    CrossrefPubMedGoogle Scholar
  • 25 Arai H, Abe T, Takagi H, Mori M. Efficacy of balloon-occluded retrograde transvenous obliteration, percutaneous transhepatic obliteration and combined techniques for the management of gastric fundal varices.  World J Gastroenterol. 2006;  12 (24) 3866-3873
    PubMedGoogle Scholar
  • 26 Arai H, Abe T, Shimoda R, Takagi H, Yamada T, Mori M. Emergency balloon-occluded retrograde transvenous obliteration for gastric varices.  J Gastroenterol. 2005;  40 (10) 964-971
    CrossrefPubMedGoogle Scholar
  • 27 Park S J, Chung J W, Kim H-C, Jae H J, Park J H. The prevalence, risk factors, and clinical outcome of balloon rupture in balloon-occluded retrograde transvenous obliteration of gastric varices.  J Vasc Interv Radiol. 2010;  21 (4) 503-507
    CrossrefPubMedGoogle Scholar
  • 28 Hong C H, Kim H J, Park J H et al.. Treatment of patients with gastric variceal hemorrhage: endoscopic N-butyl-2-cyanoacrylate injection versus balloon-occluded retrograde transvenous obliteration.  J Gastroenterol Hepatol. 2009;  24 (3) 372-378
    CrossrefPubMedGoogle Scholar
  • 29 Park K S, Kim Y H, Choi J S et al.. Therapeutic efficacy of balloon-occluded retrograde transvenous obliteration in patients with gastric variceal bleeding.  Korean J Gastroenterol. 2006;  47 (5) 370-378
    PubMedGoogle Scholar
  • 30 Kim E S, Park S Y, Kwon K T et al.. The clinical usefulness of balloon occluded retrograde transvenous obliteration in gastric variceal bleeding.  Taehan Kan Hakhoe Chi. 2003;  9 (4) 315-323
    PubMedGoogle Scholar
  • 31 Cho S K, Shin S W, Lee I H et al.. Balloon-occluded retrograde transvenous obliteration of gastric varices: outcomes and complications in 49 patients.  AJR Am J Roentgenol. 2007;  189 (6) W365-72
    PubMedGoogle Scholar
  • 32 Choi Y H, Yoon C J, Park J H, Chung J W, Kwon J W, Choi G M. Balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding: its feasibility compared with transjugular intrahepatic portosystemic shunt.  Korean J Radiol. 2003;  4 (2) 109-116
    CrossrefPubMedGoogle Scholar
  • 33 Funaro A H, Ring E J, Freiman D B, Oleaga J A, Gordon R L. Transhepatic obliteration of esophageal varices using the stainless steel coil.  AJR Am J Roentgenol. 1979;  133 (6) 1123-1125
    CrossrefPubMedGoogle Scholar
  • 34 Scott J, Dick R, Long R G, Sherlock S. Percutaneous transhepatic obliteration of gastro-oesophageal varices.  Lancet. 1976;  2 (7976) 53-55
    CrossrefPubMedGoogle Scholar
  • 35 Lunderquist A, Simert G, Tylén U, Vang J. Follow-up of patients with portal hypertension and esophageal varices treated with percutaneous obliteration of gastric coronary vein.  Radiology. 1977;  122 (1) 59-63
    PubMedGoogle Scholar
  • 36 Lunderquist A, Vang J. Transhepatic catheterization and obliteration of the coronary vein in patients with portal hypertension and esophageal varices.  N Engl J Med. 1974;  291 (13) 646-649
    CrossrefPubMedGoogle Scholar
  • 37 Lunderquist A, Vang J. Sclerosing injection of esophageal varices through transhepatic selective catheterization of the gastric coronary vein. A preliminary report.  Acta Radiol Diagn (Stockh). 1974;  15 (5) 546-550
    PubMedGoogle Scholar
  • 38 Tajiri T, Onda M, Yamashita K et al.. Interventional radiology for portal hypertension. PTO.TIO.  Nippon Geka Gakkai Zasshi. 1996;  97 (1) 70-77
    PubMedGoogle Scholar
  • 39 Fukatsu H, Kawamoto H, Harada R et al.. Gastric fundal varices with an exposed microcoil after the combined BRTO and PTO therapy.  Endoscopy. 2007;  39 (Suppl 1) E247-E248
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Olson E, Yune H Y, Klatte E C. Transrenal-vein reflux ethanol sclerosis of gastroesophageal varices.  AJR Am J Roentgenol. 1984;  143 (3) 627-628
    CrossrefPubMedGoogle Scholar
  • 41 Ferral H, Gamboa P, Postoak D W et al.. Survival after elective transjugular intrahepatic portosystemic shunt creation: prediction with model for end-stage liver disease score.  Radiology. 2004;  231 (1) 231-236
    CrossrefPubMedGoogle Scholar
  • 42 Ferral H, Patel N H. Selection criteria for patients undergoing transjugular intrahepatic portosystemic shunt procedures: current status.  J Vasc Interv Radiol. 2005;  16 (4) 449-455
    CrossrefPubMedGoogle Scholar
  • 43 Montgomery A, Ferral H, Vasan R, Postoak D W. MELD score as a predictor of early death in patients undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) procedures.  Cardiovasc Intervent Radiol. 2005;  28 (3) 307-312
    CrossrefPubMedGoogle Scholar
  • 44 Anderson C L, Saad W E, Kalagher S D et al.. Effect of transjugular intrahepatic portosystemic shunt placement on renal function: a 7-year, single-center experience.  J Vasc Interv Radiol. 2010;  21 (9) 1370-1376
    CrossrefPubMedGoogle Scholar

Wael E. A. SaadM.D. F.S.I.R. 

Department of Radiology and Medical Imaging, University of Virginia Health System

Box 800170, 1215 Lee Street, Charlottesville, VA 22908

Email: wspikes@yahoo.com