Balloon-occluded retrograde transvenous obliteration of varices: focusing on the portal hemodynamics and the recent techniques

Hepatol Int. 2018 Feb;12(Suppl 1):102-111. doi: 10.1007/s12072-017-9813-2. Epub 2017 Sep 5.

Abstract

Purpose: To evaluate the recent topics of Ballloon-occluded retrograde trasnvenous obliteration(B-RTO).

Method: We overviewed the recent scientific papers regarding B-RTO.

Result: B-RTO is a treatment method for occluding varices retrogradely using a sclerosing agent under balloon occlusion of a major draining vein. It has been recognized as an effective treatment method for gastric varices. Hepatic function reserve is improved and liver volume is increased after B-RTO. In recent years, various technical options, such as plug-assisted retrograde transvenous obliteration, coil-assisted retrograde transvenous obliteration, or foam B-RTO, have also been reported. In performing B-RTO, portal hemodynamics must be thoroughly examined radiologically. Judging the classification of the grade of collateral venous hemodynamics is important to select the appropriate embolization technique of B-RTO and to successfully occlude varices. Finally, the word "portosystemic shunt syndrome" has been proposed and the condition should be considered while selecting a treatment for gastric varices.

Conclusion: B-RTO is effective for gastrointestinal varices and portosystemic shunts.

Keywords: Balloon occlusion; Gastric varices; Portal hypertension; Retrograde obliteration; Sclerosant.

Publication types

  • Review

MeSH terms

  • Balloon Occlusion / methods*
  • Elasticity / drug effects
  • Embolization, Therapeutic / methods
  • Esophageal and Gastric Varices / therapy*
  • Hemodynamics
  • Humans
  • Hypertension, Portal / complications*
  • Hypertension, Portal / physiopathology
  • Liver / growth & development
  • Liver / physiology
  • Liver Function Tests / methods
  • Portasystemic Shunt, Surgical / adverse effects*
  • Portasystemic Shunt, Transjugular Intrahepatic / methods
  • Retrograde Obturation / instrumentation*
  • Sclerosing Solutions / administration & dosage
  • Sclerosing Solutions / therapeutic use
  • Treatment Outcome

Substances

  • Sclerosing Solutions