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Semin intervent Radiol 2011; 28(3): 303-313
DOI: 10.1055/s-0031-1284457
© Thieme Medical Publishers

Balloon-occluded Retrograde Transvenous Obliteration (BRTO): Technique and Intraprocedural Imaging

Saher S. Sabri1 , Wael E. A. Saad1
  • 1Division of Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
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Publication History

Publication Date:
15 August 2011 (online)

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ABSTRACT

Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular technique used as a therapeutic adjunct or alternative to transjugular intrahepatic shunts (TIPS) in the management of gastric varices. Occlusion balloons are strategically placed to modulate flow within the gastrorenal or gastrocaval shunt to allow stagnation of the sclerosant material within the gastric varix. The approach and complexity of the procedure depends on the anatomic classification of inflow and outflow veins of the varix. Ethanolamine oleate has been described as the main sclerosant used in this procedure. Recently, foam sclerosants have gained popularity as alternative embolization agents, which provide the advantage of better variceal wall contact and potentially less dose of sclerosant.

KEYWORDS

Gastric varices - portal hypertension - liver cirrhosis - BRTO - portosystemic shunt - embolization

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Saher S SabriM.D. 

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

Box 800170, 1215 Lee Street, Charlottesville, VA 22908

Email: ss2bp@virginia.edu