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Erschienen in: CardioVascular and Interventional Radiology 6/2018

07.02.2018 | Review

Modified Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Techniques for the Treatment of Gastric Varices: Vascular Plug-Assisted Retrograde Transvenous Obliteration (PARTO)/Coil-Assisted Retrograde Transvenous Obliteration (CARTO)/Balloon-Occluded Antegrade Transvenous Obliteration (BATO)

verfasst von: David J. Kim, Michael D. Darcy, Naganathan B. Mani, Auh Whan Park, Olaguoke Akinwande, Raja S. Ramaswamy, Seung Kwon Kim

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 6/2018

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Abstract

Gastric varices in the setting of portal hypertension occur less frequently than esophageal varices but occur at lower portal pressures and are associated with more massive bleeding events and higher mortality rate. Balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices has been well documented as an effective therapy for portal hypertensive gastric varices. However, BRTO requires lengthy, higher-level post-procedural monitoring and can have complications related to balloon rupture and adverse effects of sclerosing agents. Several modified BRTO techniques have been developed including vascular plug-assisted retrograde transvenous obliteration, coil-assisted retrograde transvenous obliteration, and balloon-occluded antegrade transvenous obliteration. This article provides an overview of various modified BRTO techniques.
Literatur
1.
Zurück zum Zitat Kim T, Shijo H, Kokawa H, Tokumitsu H, Kubara K, Ota K, et al. Risk factors for hemorrhage from gastric fundal varices. Hepatology. 1997;25:307–12.CrossRefPubMed Kim T, Shijo H, Kokawa H, Tokumitsu H, Kubara K, Ota K, et al. Risk factors for hemorrhage from gastric fundal varices. Hepatology. 1997;25:307–12.CrossRefPubMed
2.
Zurück zum Zitat Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y. Transcatheter obliteration of gastric varices. Part 1. Anatomic classification. Radiographics. 2003;23:911–20.CrossRefPubMed Kiyosue H, Mori H, Matsumoto S, Yamada Y, Hori Y, Okino Y. Transcatheter obliteration of gastric varices. Part 1. Anatomic classification. Radiographics. 2003;23:911–20.CrossRefPubMed
3.
Zurück zum Zitat Patel A, Fischman AM, Saad WE. Balloon-occluded retrograde transvenous obliteration of gastric varices. AJR Am J Roentgenol. 2012;199:721–9.CrossRefPubMed Patel A, Fischman AM, Saad WE. Balloon-occluded retrograde transvenous obliteration of gastric varices. AJR Am J Roentgenol. 2012;199:721–9.CrossRefPubMed
4.
Zurück zum Zitat Saad WE, Darcy MD. Transjugular intrahepatic portosystemic shunt (TIPS) versus balloon-occluded retrograde transvenous obliteration (BRTO) for the management of gastric varices. Semin Interv Radiol. 2011;28:339–49.CrossRef Saad WE, Darcy MD. Transjugular intrahepatic portosystemic shunt (TIPS) versus balloon-occluded retrograde transvenous obliteration (BRTO) for the management of gastric varices. Semin Interv Radiol. 2011;28:339–49.CrossRef
5.
Zurück zum Zitat Ferral H, Gamboa P, Postoak DW, Albernaz VS, Young CR, Speeg KV, et al. Survival after elective transjugular intrahepatic portosystemic shunt creation: prediction with model for end-stage liver disease score. Radiology. 2004;231:231–6.CrossRefPubMed Ferral H, Gamboa P, Postoak DW, Albernaz VS, Young CR, Speeg KV, et al. Survival after elective transjugular intrahepatic portosystemic shunt creation: prediction with model for end-stage liver disease score. Radiology. 2004;231:231–6.CrossRefPubMed
6.
Zurück zum Zitat Montgomery A, Ferral H, Vasan R, Postoak DW. MELD score as a predictor of early death in patients undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) procedures. Cardiovasc Interv Radiol. 2005;28:307–12.CrossRef Montgomery A, Ferral H, Vasan R, Postoak DW. MELD score as a predictor of early death in patients undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) procedures. Cardiovasc Interv Radiol. 2005;28:307–12.CrossRef
7.
Zurück zum Zitat Ryan BM, Stockbrugger RW, Ryan JM. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterology. 2004;126(4):1175–89.CrossRefPubMed Ryan BM, Stockbrugger RW, Ryan JM. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterology. 2004;126(4):1175–89.CrossRefPubMed
8.
Zurück zum Zitat Tripathi D, Stanley AJ, Hayes PC, Clinical Services and Standards Committee of the British Society of Gastroenterology, et al. U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 2015;64:1680–704.CrossRefPubMedPubMedCentral Tripathi D, Stanley AJ, Hayes PC, Clinical Services and Standards Committee of the British Society of Gastroenterology, et al. U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 2015;64:1680–704.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Cho SK, Shin SW, Lee IH, Do YS, Choo SW, Park KB, et al. Balloon-occluded retrograde transvenous obliteration of gastric varices: outcomes and complications in 49 patients. AJR Am J Roentgenol. 2007;189:W365–72.CrossRefPubMed Cho SK, Shin SW, Lee IH, Do YS, Choo SW, Park KB, et al. Balloon-occluded retrograde transvenous obliteration of gastric varices: outcomes and complications in 49 patients. AJR Am J Roentgenol. 2007;189:W365–72.CrossRefPubMed
10.
Zurück zum Zitat 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;12:327–36.CrossRefPubMed 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;12:327–36.CrossRefPubMed
11.
Zurück zum Zitat Henderson JM, Nagle A, Curtas S, Geisinger M, Barnes D. Surgical shunts and TIPS for variceal decompression in the 1990s. Surgery. 2000;128:540–7.CrossRefPubMed Henderson JM, Nagle A, Curtas S, Geisinger M, Barnes D. Surgical shunts and TIPS for variceal decompression in the 1990s. Surgery. 2000;128:540–7.CrossRefPubMed
12.
Zurück zum Zitat Hirota S, Matsumoto S, Tomita M, Sako M, Kono M. Retrograde transvenous obliteration of gastric varices. Radiology. 1999;211:349–56.CrossRefPubMed Hirota S, Matsumoto S, Tomita M, Sako M, Kono M. Retrograde transvenous obliteration of gastric varices. Radiology. 1999;211:349–56.CrossRefPubMed
13.
Zurück zum Zitat 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;11:51–8.CrossRefPubMed 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;11:51–8.CrossRefPubMed
14.
Zurück zum Zitat Saad WE, Sabri SS. Balloon-occluded retrograde transvenous obliteration (BRTO): technical results and outcomes. Semin Interv Radiol. 2011;28:333–8.CrossRef Saad WE, Sabri SS. Balloon-occluded retrograde transvenous obliteration (BRTO): technical results and outcomes. Semin Interv Radiol. 2011;28:333–8.CrossRef
15.
Zurück zum Zitat Shimoda R, Horiuchi K, Hagiwara S, Suzuki H, Yamazaki Y, Kosone T, 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;30:306–13.CrossRefPubMed Shimoda R, Horiuchi K, Hagiwara S, Suzuki H, Yamazaki Y, Kosone T, 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;30:306–13.CrossRefPubMed
16.
Zurück zum Zitat Chikamori F, Shibuya S, Takase Y, Ozaki A, Fukao K. Transjugular retrograde obliteration for gastric varices. Abdom Imaging. 1996;21:299–303.CrossRefPubMed Chikamori F, Shibuya S, Takase Y, Ozaki A, Fukao K. Transjugular retrograde obliteration for gastric varices. Abdom Imaging. 1996;21:299–303.CrossRefPubMed
17.
Zurück zum Zitat Olson E, Yune HY, Klatte EC. Transrenal-vein reflux ethanol sclerosis of gastroesophageal varices. AJR Am J Roentgenol. 1984;143:627–8.CrossRefPubMed Olson E, Yune HY, Klatte EC. Transrenal-vein reflux ethanol sclerosis of gastroesophageal varices. AJR Am J Roentgenol. 1984;143:627–8.CrossRefPubMed
18.
Zurück zum Zitat 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;23:921–37 (discussion 37).CrossRefPubMed 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;23:921–37 (discussion 37).CrossRefPubMed
19.
Zurück zum Zitat Choi SY, Won JY, Kim KA, Lee DY, Lee KH. Foam sclerotherapy using polidocanol for balloon-occluded retrograde transvenous obliteration (BRTO). Eur Radiol. 2011;21:122–9.CrossRefPubMed Choi SY, Won JY, Kim KA, Lee DY, Lee KH. Foam sclerotherapy using polidocanol for balloon-occluded retrograde transvenous obliteration (BRTO). Eur Radiol. 2011;21:122–9.CrossRefPubMed
20.
Zurück zum Zitat Gwon DI, Ko GY, Yoon HK, Sung KB, Kim JH, Shin JH, et al. Gastric varices and hepatic encephalopathy: treatment with vascular plug and gelatin sponge-assisted retrograde transvenous obliteration—a primary report. Radiology. 2013;268:281–7.CrossRefPubMed Gwon DI, Ko GY, Yoon HK, Sung KB, Kim JH, Shin JH, et al. Gastric varices and hepatic encephalopathy: treatment with vascular plug and gelatin sponge-assisted retrograde transvenous obliteration—a primary report. Radiology. 2013;268:281–7.CrossRefPubMed
21.
Zurück zum Zitat Saad WE. Balloon-occluded retrograde transvenous obliteration of gastric varices: concept, basic techniques, and outcomes. Semin Interv Radiol. 2012;29:118–28.CrossRef Saad WE. Balloon-occluded retrograde transvenous obliteration of gastric varices: concept, basic techniques, and outcomes. Semin Interv Radiol. 2012;29:118–28.CrossRef
22.
Zurück zum Zitat Kim YH, Kim YH, Kim CS, Kang UR, Kim SH, Kim JH. Comparison of balloon-occluded retrograde transvenous obliteration (BRTO) using ethanolamine oleate (EO), BRTO using sodium tetradecyl sulfate (STS) foam and vascular plug-assisted retrograde transvenous obliteration (PARTO). Cardiovasc Interv Radiol. 2016;39:840–6.CrossRef Kim YH, Kim YH, Kim CS, Kang UR, Kim SH, Kim JH. Comparison of balloon-occluded retrograde transvenous obliteration (BRTO) using ethanolamine oleate (EO), BRTO using sodium tetradecyl sulfate (STS) foam and vascular plug-assisted retrograde transvenous obliteration (PARTO). Cardiovasc Interv Radiol. 2016;39:840–6.CrossRef
23.
Zurück zum Zitat Lee EW, So N, Chapman R, McWilliams JP, Loh CT, Busuttil RW, et al. Usefulness of intra-procedural cone-beam computed tomography in modified balloon-occluded retrograde transvenous obliteration of gastric varices. World J Radiol. 2016;8:390–6.CrossRefPubMedPubMedCentral Lee EW, So N, Chapman R, McWilliams JP, Loh CT, Busuttil RW, et al. Usefulness of intra-procedural cone-beam computed tomography in modified balloon-occluded retrograde transvenous obliteration of gastric varices. World J Radiol. 2016;8:390–6.CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Chang MY, Kim MD, Kim T, Shin W, Shin M, Kim GM, et al. Plug-assisted retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage. Korean J Radiol. 2016;17:230–8.CrossRefPubMedPubMedCentral Chang MY, Kim MD, Kim T, Shin W, Shin M, Kim GM, et al. Plug-assisted retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage. Korean J Radiol. 2016;17:230–8.CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Kim T, Yang H, Lee CK, Kim GB. Vascular plug assisted retrograde transvenous obliteration (PARTO) for gastric varix bleeding patients in the emergent clinical setting. Yonsei Med J. 2016;57:973–9.CrossRefPubMedPubMedCentral Kim T, Yang H, Lee CK, Kim GB. Vascular plug assisted retrograde transvenous obliteration (PARTO) for gastric varix bleeding patients in the emergent clinical setting. Yonsei Med J. 2016;57:973–9.CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Gwon DI, Kim YH, Ko GY, Kim JW, Ko HK, Kim JH, et al. Vascular plug-assisted retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy: a prospective multicenter study. J Vasc Interv Radiol. 2015;26:1589–95.CrossRefPubMed Gwon DI, Kim YH, Ko GY, Kim JW, Ko HK, Kim JH, et al. Vascular plug-assisted retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy: a prospective multicenter study. J Vasc Interv Radiol. 2015;26:1589–95.CrossRefPubMed
27.
Zurück zum Zitat Lee EW, Saab S, Gomes AS, Busuttil R, McWilliams J, Durazo F, et al. Coil-assisted retrograde transvenous obliteration (CARTO) for the treatment of portal hypertensive variceal bleeding: preliminary results. Clin Transl Gastroenterol. 2014;5:e61.CrossRefPubMedPubMedCentral Lee EW, Saab S, Gomes AS, Busuttil R, McWilliams J, Durazo F, et al. Coil-assisted retrograde transvenous obliteration (CARTO) for the treatment of portal hypertensive variceal bleeding: preliminary results. Clin Transl Gastroenterol. 2014;5:e61.CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Saad WE, Sze DY. Variations of balloon-occluded retrograde transvenous obliteration (BRTO): balloon-occluded antegrade transvenous obliteration (BATO) and alternative/adjunctive routes for BRTO. Semin Interv Radiol. 2011;28(314–24):26. Saad WE, Sze DY. Variations of balloon-occluded retrograde transvenous obliteration (BRTO): balloon-occluded antegrade transvenous obliteration (BATO) and alternative/adjunctive routes for BRTO. Semin Interv Radiol. 2011;28(314–24):26.
29.
Zurück zum Zitat Saad WE, Kitanosono T, Koizumi J. Balloon-occluded antegrade transvenous obliteration with or without balloon-occluded retrograde transvenous obliteration for the management of gastric varices: concept and technical applications. Tech Vasc Interv Radiol. 2012;15:203–25.CrossRefPubMed Saad WE, Kitanosono T, Koizumi J. Balloon-occluded antegrade transvenous obliteration with or without balloon-occluded retrograde transvenous obliteration for the management of gastric varices: concept and technical applications. Tech Vasc Interv Radiol. 2012;15:203–25.CrossRefPubMed
30.
Zurück zum Zitat Gaba RC. Retrograde-antegrade accelerated trap obliteration: a modified approach to transvenous eradication of gastric varices. J Vasc Interv Radiol. 2017;28(2):291–4.CrossRefPubMed Gaba RC. Retrograde-antegrade accelerated trap obliteration: a modified approach to transvenous eradication of gastric varices. J Vasc Interv Radiol. 2017;28(2):291–4.CrossRefPubMed
Metadaten
Titel
Modified Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Techniques for the Treatment of Gastric Varices: Vascular Plug-Assisted Retrograde Transvenous Obliteration (PARTO)/Coil-Assisted Retrograde Transvenous Obliteration (CARTO)/Balloon-Occluded Antegrade Transvenous Obliteration (BATO)
verfasst von
David J. Kim
Michael D. Darcy
Naganathan B. Mani
Auh Whan Park
Olaguoke Akinwande
Raja S. Ramaswamy
Seung Kwon Kim
Publikationsdatum
07.02.2018
Verlag
Springer US
Erschienen in
CardioVascular and Interventional Radiology / Ausgabe 6/2018
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-018-1896-1

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