Read by QxMD icon Read

Balloon-occluded Retrograde Transvenous Obliteration

Sana Basseri, Christopher B Lightfoot
Gastric variceal bleeding is a major complication of portal hypertension and is associated with high morbidity and mortality. While esophageal varices are more common, gastric varices are often more challenging to treat. Balloon-Occluded Retrograde Transvenous Obliteration is an interventional procedure whereby the portosystemic gastrorenal shunt is accessed via the left renal vein and the gastric varix outflow tract obliterated using direct sclerotherapy. Herein, we present a case of a 68-year-old female patient with cirrhosis who presented with bleeding gastric varices and successfully treated...
December 2016: Radiology case reports
Takahiko Mine, Tomohiro Matsumoto, Jun Endo, Kazunobu Hashida, Seiichiro Kojima, Norihito Watanabe, Terumitsu Hasebe
We here present a case involving a complicated type of gastric fundal varices treated by balloon-occluded retrograde transvenous obliteration. A newly developed 1.8-Fr tip coaxial microballoon catheter was successfully advanced into narrow and tortuous varices, and a sclerosant could be infused in a reasonable manner, avoiding reflux into collaterals. Divided injections of sclerosant were performed over two days, via a microballoon catheter that remained inserted overnight with balloon inflation, and the sclerosant could be infused sufficiently in the entirety of the varices...
November 1, 2016: Minimally Invasive Therapy & Allied Technologies: MITAT
Catherine E Hansing, Joseph P Marquardt, Daniel M Sutton, John D York
Arteriovenous malformations (AVMs) are a high-flow form of a vascular malformation, which can be found anywhere in the body. While historically treated surgically, a multidisciplinary approach utilizing multiple specialties and treatment modalities is now commonly employed. In order to effectively treat an AVM, the nidus must be targeted and eradicated, which can be done via multiple approaches. We present the case of a 43-year-old male with a gastric wall AVM, which was initially incompletely treated using a percutaneous transarterial approach...
September 26, 2016: Cardiovascular and Interventional Radiology
Go Anegawa, Kenji Sumi, Atsushi Miyoshi, Kenji Kitahara, Seiji Satou
BACKGROUND: Duodenal varices are a low-frequency cause of gastrointestinal bleeding; however, greater than 40 % mortality has been reported after the initial bleeding episode. CASE PRESENTATION: This report describes a 72-year-old woman with bleeding duodenal varices treated by surgery after failure of balloon-occluded retrograde transvenous obliteration (B-RTO). The patient presented with profuse melena. Emergent upper endoscopy was immediately performed, and bleeding duodenal varices in the second portion of the duodenum were seen...
December 2016: Surgical Case Reports
Qiong Wu, Hua Jiang, Enqiang Linghu, Lanjing Zhang, Weifeng Wang, Jie Zhang, Zhandi He, Juan Wang, Yunsheng Yang, Guohui Sun, Gang Sun
AIMS: We evaluated the feasibility, efficacy and safety of a novel technique of balloon-occluded retrograde transvenous obliteration (BRTO) assisted endoscopic Histoacryl (N-buthyl-2-cyanoacrylate) injection. MATERIAL AND METHODS: A total with 11 patients were enrolled and analyzed in this single center, open-label, prospective study. Patients with high-risk gastric varices (defined as fundal varices, large GV (>5 mm), presence of a red spot, and Child-Pugh score C) and concurrent gastrorenal shunt underwent endoscopic Histoacryl injection while the gastrorenal shunt was temporarily occluded with an occlusion balloon...
June 16, 2016: Minimally Invasive Therapy & Allied Technologies: MITAT
Daniel T Ginat, Wael Saad, Takashi Kitanono
Balloon-retrograde transvenous obliteration (BRTO) can be an appropriate treatment modality for hepatic encephalopathy in the setting of portal-systemic shunting in selected patients. We describe a case of a large gastro-renal shunt that was successfully treated via combined BRTO and expandable hydrogel-coated coil embolization, with an emphasis on technique.
2009: Radiology case reports
Akira Yamamoto, Norifumi Nishida, Hiroyasu Morikawa, Atsushi Jogo, Ken Kageyama, Etsuji Sohgawa, Shinichi Hamamoto, Toru Takeshita, Yukimasa Sakai, Toshiyuki Matsuoka, Norifumi Kawada, Yukio Miki
PURPOSE: To investigate predictive factors and cutoff value of transient elastography (TE) measurements for assessing improvement in liver function after balloon-occluded retrograde transvenous obliteration (BRTO) for gastric varices (GV). MATERIALS AND METHODS: Retrospective analysis was performed of 50 consecutive patients followed for > 3 months after BRTO, who had undergone TE before BRTO between January 2011 and February 2015. The correlation between change in liver function (total bilirubin, albumin, and prothrombin time) and baseline liver function values and liver stiffness measurement (LSM) by TE was evaluated by Pearson correlation test...
August 2016: Journal of Vascular and Interventional Radiology: JVIR
Edward Wolfgang Lee, Naomi So, Ryan Chapman, Justin P McWilliams, Christopher T Loh, Ronald W Busuttil, Stephen T Kee
AIM: To evaluate whether intra-procedural cone-beam computed tomography (CBCT) performed during modified balloon-occluded retrograde transvenous obliteration (mBRTO) can accurately determine technical success of complete variceal obliteration. METHODS: From June 2012 to December 2014, 15 patients who received CBCT during mBRTO for treatment of portal hypertensive gastric variceal bleeding were retrospectively evaluated. Three-dimensional (3D) CBCT images were performed and evaluated prior to the end of the procedure, and these were further analyzed and compared to the pre-procedure contrast-enhanced computed tomography to determine the technical success of mBRTO including: Complete occlusion/obliteration of: (1) gastrorenal shunt (GRS); (2) gastric varices; and (3) afferent feeding veins...
April 28, 2016: World Journal of Radiology
David Koch
PURPOSE OF REVIEW: This article discusses the most recent studies regarding the management of gastric varices. RECENT FINDINGS: New case series and meta-analyses have increased our understanding of the endoscopic and endovascular treatment options for patients with gastric varices, including the use of cyanoacrylates, the potential increased utility of endoscopic ultrasound over conventional endoscopy and the emerging role of balloon-occluded retrograde transvenous obliteration...
May 2016: Current Opinion in Gastroenterology
Nobuyuki Toshikuni, Yoshitaka Takuma, Mikihiro Tsutsumi
Bleeding from gastroesophageal varices (GEV) is a serious event in cirrhotic patients and can cause death. According to the explosion theory, progressive portal hypertension is the primary mechanism underlying variceal bleeding. There are two approaches for treating GEV: primary prophylaxis to manage bleeding or emergency treatment for bleeding followed by secondary prophylaxis. Treatment methods can be classified into two categories: 1) Those used to decrease portal pressure, such as medication (i.e., nonselective β-blockers), radiological intervention [transjugular intrahepatic portosystemic shunt (TIPS)] or a surgical approach (i...
May 2016: Annals of Hepatology
Masashi Takano, Yukinori Imai, Manabu Nakazawa, Taku Chikayama, Satsuki Ando, Kayoko Sugawara, Nobuaki Nakayama, Satoshi Mochida
A 66-year-old male patient with liver cirrhosis because of alcohol intake underwent a Hartmann's procedure for rectal cancer. Four months later, bleeding from the sigmoid stoma occurred and persisted for 2 months. A colonoscopic examination revealed bleeding from stomal varices. Three-dimensional computed tomography (CT) imaging demonstrated the inferior mesenteric vein and left superficial epigastric vein as the feeding and drainage vessels, respectively. Balloon-occluded retrograde transvenous obliteration (B-RTO) through the left epigastric vein was performed using a microballoon catheter inserted from the right femoral vein according to the Seldinger method...
June 2016: Clinical Journal of Gastroenterology
Yukinori Imai, Manabu Nakazawa, Satsuki Ando, Kayoko Sugawara, Satoshi Mochida
AIM: To clarify the long-term outcome of therapeutic strategies including balloon-occluded retrograde transvenous obliteration (B-RTO) for patients with gastric fundal varices. METHODS: The subjects were 154 patients with gastric fundal varices fulfilling the criteria for receiving B-RTO. In patients showing variceal bleeding, endoscopic therapies and/or balloon tamponade was done to achieve hemostasis. B-RTO was accomplished with injection of 5% ethanolamine oleate through a standard-balloon catheter except for patients with atypical varices, in whom a microballoon catheter was used to occlude drainage vessels other than a gastrorenal shunt...
March 22, 2016: Journal of Gastroenterology and Hepatology
Takahiko Mine, Satoru Murata, Ken Nakazawa, Shiro Onozawa, Tatsuo Ueda, Shinichiro Kumita
Here, we present the case of a 51-year-old woman with high-output congestive heart failure caused by a large pelvic arteriovenous malformation. Endovascular treatment that combined arterial nidus embolization with n-butyl 2-cyanoacrylate, coil embolization of the venous component, and balloon-occluded retrograde transvenous obliteration was performed. A promising therapeutic outcome was achieved without recurrence of symptoms over a 3-year period. The combination of these techniques to control arterial inflow and venous outflow is a novel method for the treatment of large pelvic arteriovenous malformation...
April 2013: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Nobuo Waguri, Akihiko Osaki, Shunzo Ikarashi, Masahiro Ogawa, Naosuke Kuraoka, Kohei Ogawa, Munehiro Sato, Tsuneo Aiba, Osamu Yoneyama, Koichi Furukawa, Kazuhito Sugimura, Kentarou Igarashi
BACKGROUND: We previously reported the techniques and usefulness of simultaneous combined balloon-occluded retrograde transvenous obliteration (B-RTO) and partial splenic embolization (PSE), based on the hypothesis that concomitant PSE can diminish the increase in portal venous pressure after B-RTO. OBJECTIVE: After experiencing more cases and performing longer-term follow-up, we re-evaluated the efficacy of simultaneous combined B-RTO and PSE for gastric fundal varices (GVs)...
February 2016: United European Gastroenterology Journal
Il Soo Chang, Sang Woo Park, So Young Kwon, Won Hyeok Choe, Young Koog Cheon, Chan Sup Shim, Tae Yoon Lee, Jeong Han Kim
OBJECTIVE: To evaluate the efficacy and safety of balloon-occluded retrograde transvenous obliteration (BRTO) with sodium tetradecyl sulfate (STS) liquid sclerotherapy of gastric varices. MATERIALS AND METHODS: Between February 2012 and August 2014, STS liquid sclerotherapy was performed in 17 consecutive patients (male:female = 8:9; mean age 58.6 years, range 44-86 years) with gastric varices. Retrograde venography was performed after occlusion of the gastrorenal shunt using a balloon catheter and embolization of collateral draining veins using coils or gelfoam pledgets, to evaluate the anatomy of the gastric varices...
March 2016: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
Kazufumi Kobayashi, Hitoshi Maruyama, Soichiro Kiyono, Tadashi Sekimoto, Takayuki Kondo, Taro Shimada, Masanori Takahashi, Hidehiro Okugawa, Osamu Yokosuka
AIM: To determine the prognostic effect of portal hemodynamic responses after balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices (GV) in cirrhosis patients. METHODS: This retrospective study consisted of 37 cirrhosis patients (62.5 ± 9.7 years) with medium- or large-grade GV treated with B-RTO. Portal hemodynamic response was assessed by the changes in flow volume in the portal trunk (PFV, mL/min) before and after the treatment; Group I showed increased PFV and Group II showed no increase in PFV...
March 2, 2016: Hepatology Research: the Official Journal of the Japan Society of Hepatology
P A Shukla, A Kumar, M K Kolber, T Markowitz, R I Patel
No abstract text is available yet for this article.
April 2016: Diagnostic and Interventional Imaging
Young Hwan Kim, Young Hwan Kim, Chan Sun Kim, Ung Rae Kang, See Hyung Kim, Joo Hwan Kim
PURPOSE: To compare the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) using ethanolamine oleate (EO), BRTO using sodium tetradecyl sulfate (STS) foam, and vascular plug-assisted retrograde transvenous obliteration (PARTO). MATERIALS AND METHODS: From April 2004 to February 2015, ninety-five patients underwent retrograde transvenous obliteration for gastric varices were analyzed retrospectively. BRTO with EO was performed in 49 patients, BRTO with STS foam in 25, and PARTO in 21...
June 2016: Cardiovascular and Interventional Radiology
Kawtar Al Khalloufi, Adeyinka O Laiyemo
Rectal varices are portosystemic collaterals that form as a complication of portal hypertension, their prevalence has been reported as high as 94% in patients with extrahepatic portal vein obstruction. The diagnosis is typically based on lower endoscopy (colonoscopy or sigmoidoscopy). However, endoscopic ultrasonography has been shown to be superior to endoscopy in diagnosing rectal varices. Color Doppler ultrasonography is a better method because it allows the calculation of the velocity of blood flow in the varices and can be used to predict the bleeding risk in the varices...
December 28, 2015: World Journal of Hepatology
Miyuki Maruno, Hiro Kiyosue, Shuichi Tanoue, Norio Hongo, Hiromu Mori
Balloon-occluded retrograde transvenous obliteration (BRTO) is an effective and minimally invasive treatment for isolated gastric varices (GVs) that is usually performed through a gastrorenal shunt (GRS) or gastrocaval shunt (GCS). However, there are some cases in which GVs drain mainly into the left pericardiophrenic vein without an accessible GRS or GCS. This brief report presents four cases of GVs without a GRS/GCS treated by BRTO through the pericardiophrenic vein. BRTO was successfully performed with the use of flexible balloon catheters without any complications in all four patients, and the GVs were completely obliterated...
February 2016: Journal of Vascular and Interventional Radiology: JVIR
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"