Semin intervent Radiol 2018; 35(03): 169-184
DOI: 10.1055/s-0038-1660795
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Endovascular Treatment for Variceal Hemorrhage: TIPS, BRTO, and Combined Approaches

Andrew J. Lipnik
1  Department of Radiology, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
2  Division of Interventional Radiology, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
,
Mithil B. Pandhi
1  Department of Radiology, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
,
Ramzy C. Khabbaz
1  Department of Radiology, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
,
Ron C. Gaba
1  Department of Radiology, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
2  Division of Interventional Radiology, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

Publication Date:
06 August 2018 (online)

Abstract

Variceal hemorrhage is a feared complication of portal hypertension, with high rates of morbidity and mortality. Optimal management requires a thoughtful, multidisciplinary approach. In cases of refractory or recurrent esophageal hemorrhage, endovascular approaches such as transjugular intrahepatic portosystemic shunt (TIPS) have a well-defined role. For hemorrhage related to gastric varices, the optimal treatment remains to be established; however, there is increasing adoption of balloon-occluded retrograde transvenous obliteration (BRTO). This article will review the concept, history, patient selection, basic technique, and outcomes for TIPS, BRTO, and combined TIPS + BRTO procedures for variceal hemorrhage.