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Digestive Disease Interventions 2017; 01(04): 293-301
DOI: 10.1055/s-0038-1632364
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Plug-Assisted Retrograde Transvenous Obliteration

Eung Tae Kim
1   Department of radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea
,
Dong Il Gwon
1   Department of radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea
› Author Affiliations
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Publication History

22 February 2017

03 January 2018

Publication Date:
22 February 2018 (online)

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Abstract

Gastric fundal varices and portosystemic hepatic encephalopathy are major complications of portal hypertension in patients with liver cirrhosis. Many treatment options have been used for gastric varices, including endoscopic injection and transjugular intrahepatic portosystemic shunts (TIPS), but the clinical effectiveness of these treatments remains contentious. Today, balloon-occluded retrograde transvenous obliteration (BRTO) has become the treatment of choice because of its excellent clinical effectiveness and outcomes; however, the associated use of sclerosants and temporary indwelling balloon catheters can cause specific complications. Vascular plugs are another option that has been shown to be safe, feasible, and effective when used as an embolic material in vascular disease. Recently, a technique has been developed that uses such vascular plugs with a gelatin sponge to embolize gastrorenal shunts. This technique is known as plug-assisted retrograde transvenous obliteration (PARTO), and it is also associated with high technical and clinical success rates. Moreover, it appears to be a much safer and more feasible procedure than BRTO. In this review, we introduce PARTO and outline its strengths and potential for use as the treatment of choice in gastric varices and hepatic encephalopathy.

Keywords

PARTO - vascular plug - esophageal and gastric varices - hepatic encephalopathy - liver cirrhosis - gelatin sponge
 

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