Balloon Occluded Retrograde Transvenous Obliteration (BRTO)—Mastering the Art with CT Scan

Introduction: BRTO/ PARTO is now well accepted minimally invasive treatment for gastric varices (GVs). Success of BRTO depends on understanding the hemodynamics and pattern of afferent and efferent veins. Preprocedure CT scan can help us to plan, ascertain the difficulties, and choose appropriate hardware.

Method(s): Sixty-one cases of GVs and hepatic encephalopathy (HE) in the presence of porto-systemic shunt treated with BRTO/ PARTO over past 6 years were retrospectively analyzed. Preprocedure CT scans were analyzed to guide regarding access (jugular/femoral), hardware (sheaths, catheter, balloon, plug, coils), embolizing agent (sclerosant/gelfoam), complexity of procedure (multiple afferent or efferent veins, need for transhepatic access, and embolization).

Result(s): Procedure was technically easier from femoral route. Inferiorly directed left renal veins and longer distance (>3.5 cm) between IVC and gastro-renal shunt were better accessed through jugular veins. Curved sheaths preferred during jugular access. In larger shunts plug was preferred over balloon.

Conclusion(s): Detailed analysis of preprocedure CT scans can help us to plan, predict difficulties, and achieve high technical success with durable clinical efficacy for the treatment of GVs and HE.

Publication History

Article published online:
09 February 2023