Abstract
Coil-assisted retrograde transvenous obliteration (CARTO) has evolved as a simpler
and perhaps safer alternative to balloon-occluded retrograde transvenous obliteration
(BRTO). The efficacy of BRTO has been established, and early data supports the use
of CARTO in similar situations. In a small series of patients with gastric variceal
hemorrhage treated with CARTO, complete portosystemic shunt occlusion, complete variceal
obliteration, and no rebleeding during the follow-up period were observed in all patients.
In a larger, unpublished study, an improvement in hepatic encephalopathy was observed
in over 80% of patients treated with CARTO. In addition, overall liver function was
markedly improved in 1 month. As for complications, new or worsened ascites and esophageal
varices were observed in 24% and 30%, respectively. Overall, CARTO is an effective
treatment of gastric variceal hemorrhage and hepatic encephalopathy with high technical
and clinical success rates. Compared with plug-assisted retrograde transvenous obliteration
(PARTO), CARTO can be used to safely close larger shunts with a comparable efficacy
and complication profiles.
Keywords
CARTO - BRTO - gastric variceal hemorrhage - hepatic encephalopathy
