The two clinical indications for BRTO are gastric variceal bleeding (impending, prior or current or active) and, to a lesser extent, refractory debilitating hepatic encephalopathy. The indications of concomitant portal venous modulators such as splenic embolization or the creation of a transjugular intrahepatic portosystemic shunt (TIPS) are briefly mentioned. This chapter discusses the indications, contraindications, and technical considerations of the conventional BRTO procedure. 1, 6 The objective of BRTO and BATO is complete obliteration of the gastric varices while preserving anatomical hepatopetal flow of the splenoportal circulation. However, BATO is considered an alternative or adjunctive approach. 1 BRTO is the conventional obliterative procedure because it is the least invasive choice of access or approach via a transfemoral, transrenal route 2– 5 ( Fig. However, when balloon-occluded transvenous obliteration is performed from the portal vein and its afferent feeders, it is referred to as balloon-occluded antegrade transvenous obliteration (BATO) ( Fig. When balloon-occluded transvenous obliteration is performed from the systemic veins, it is referred to as balloon-occluded retrograde transvenous obliteration (BRTO) ( Fig. Transvenous obliteration of gastric varices can be performed from the systemic-venous side (draining veins/shunts) or from the portal-venous side (portal afferent feeders). Chapter 29: The Conventional Balloon-Occluded Retrograde Transvenous Obliteration Procedure
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