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Balloon-occluded Retrograde Transvenous Obliteration

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https://www.readbyqxmd.com/read/28180928/safety-and-efficacy-of-sodium-tetradecyl-sulfate-and-lipiodol-foam-in-balloon-occluded-retrograde-transvenous-obliteration-brto-for-large-porto-systemic-shunts
#1
Amar Mukund, Ganesh Deogaonkar, S Rajesh, Saggerre Muralikrishna Shasthry, Shiv Kumar Sarin
OBJECTIVE: To evaluate the safety and efficacy sodium tetradecyl sulfate and lipiodol foam (STS foam) in BRTO for large (caliber ≥15 mm) porto-systemic shunt and gastric fundal varices. MATERIALS AND METHODS: It is a retrospective record-based study of patients who underwent BRTO using STS foam at the Institute of Liver and Biliary Sciences, New Delhi, for gastric variceal bleed or refractory hepatic encephalopathy (HE) who had large porto-systemic shunt (diameter ≥15 mm) with or without associated gastric varices...
February 8, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28135795/-surgical-removal-of-migrated-coil-after-embolization-of-jejunal-variceal-bleeding-a-case-report
#2
Junhwan Kim, Danbi Lee, Kyunghwan Oh, Mingee Lee, Seol So, Dong Hoon Yang, Chan Wook Kim, Dong Il Gwon, Young Hwa Chung
Jejunal variceal bleeding is less common compared with esophagogastric varices in patients with portal hypertension. However, jejunal variceal bleeding can be fatal without treatment. Treatments include surgery, transjugular intrahepatic porto-systemic shunt (TIPS), endoscopic sclerotherapy, percutaneous coil embolization, and balloon-occluded retrograde transvenous obliteration (BRTO). Percutaneous coil embolization can be considered as an alternative treatment option for those where endoscopic sclerotherapy, surgery, TIPS or BRTO are not possible...
January 25, 2017: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
https://www.readbyqxmd.com/read/28123716/percutaneous-transhepatic-obliteration-and-percutaneous-transhepatic-sclerotherapy-for-intractable-hepatic-encephalopathy-and-gastric-varices-improves-the-hepatic-function-reserve
#3
Toru Ishikawa, Michitaka Imai, Masayoshi Ko, Hiroki Sato, Yujiro Nozawa, Tomoe Sano, Akito Iwanaga, Keiichi Seki, Terasu Honma, Toshiaki Yoshida
Percutaneous transhepatic obliteration (PTO) and percutaneous transhepatic sclerotherapy (PTS) are widely performed as an emergency measure in cases of variceal hemorrhage and intractable hepatic encephalopathy. The PTO/PTS technique is capable of directly blocking the blood supply in cases in which balloon-occluded retrograde transvenous obliteration (B-RTO) is not effective, or in cases with complicated collateral flow. Although PTO/PTS is not currently the first choice due to the invasiveness of transhepatic puncture, this procedure can modify the blood flow in an antegrade manner...
January 2017: Biomedical Reports
https://www.readbyqxmd.com/read/28102583/successful-splenorenal-shunt-occlusion-with-balloon-occluded-retrograde-transvenous-obliteration-yielded-improvement-of-residual-liver-function-enabled-administration-of-direct-acting-antivirals-and-achieved-sustained-virologic-response-to-hepatitis-c-virus
#4
Hironori Ochi, Michiko Aono, Shunji Takechi, Toshie Mashiba, Tomoyuki Yokota, Kouji Joko
We report the use of balloon-occluded retrograde transvenous obliteration (BRTO) for portosystemic shunt in one patient, resulting in marked improvements in residual liver function and enabling safe hepatitis C virus (HCV) elimination with direct-acting antiviral agents. A woman undergoing outpatient treatment at our institution for HCV-related cirrhosis with a history of hepatocellular carcinoma (HCC) treatment developed hepatic encephalopathy (HE; Child-Pugh score 8) at age 65 years. Improvement was obtained with conservative treatment; however, contrast-enhanced computed tomography revealed a splenorenal shunt with decreased portal vein blood flow...
January 19, 2017: Journal of Digestive Diseases
https://www.readbyqxmd.com/read/28058594/an-algorithm-for-management-after-transjugular-intrahepatic-portosystemic-shunt-placement-according-to-clinical-manifestations
#5
REVIEW
Seung Kwon Kim, Bryan G Belikoff, Carlos J Guevara, Seong Jin Park
We propose an algorithm for management after transjugular intrahepatic portosystemic shunt (TIPS) placement according to clinical manifestations. For patients with an initial good clinical response, surveillance Doppler ultrasound is recommended to detect stenosis or occlusion. A TIPS revision can be performed using basic or advanced techniques to treat stenosis or occlusion. In patients with an initial poor clinical response, a TIPS venogram with pressure measurements should be performed to assess shunt patency...
January 5, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28003724/balloon-occluded-retrograde-transvenous-obliteration-brto-a-novel-method-of-control-of-bleeding-from-post-glue-ulcer-over-gastric-varices-report-of-two-cases-and-review-of-literature
#6
Ritesh Prajapati, Piyush Ranjan, Arun Gupta, Ajit K Yadav
Bleeding gastric varices (GV) are managed by cyanoacrylate glue injection with transjugular intrahepatic portosystemic shunt (TIPSS) as modality for treatment failure. Ulcer can form at the site of glue injection over GV and it can cause bleeding. Treatment approach for such bleed is not well described. Balloon-occluded retrograde transvenous obliteration (BRTO), TIPSS, and devascularization remain the treatment options in this scenario. BRTO is an endovascular procedure where a balloon catheter is inserted into a draining vein of GV, and the sclerosant can be injected into the varices through the catheter during balloon occlusion...
December 2016: Journal of Clinical and Experimental Hepatology
https://www.readbyqxmd.com/read/27920863/balloon-occluded-retrograde-transvenous-obliteration-for-treatment-of-bleeding-gastric-varices-case-report-and-review-of-literature
#7
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
https://www.readbyqxmd.com/read/27801607/balloon-occluded-retrograde-transvenous-obliteration-using-a-new-microballoon-for-gastric-varices
#8
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
https://www.readbyqxmd.com/read/27671152/balloon-occluded-retrograde-transvenous-obliteration-of-a-gastric-vascular-malformation-an-innovative-approach-to-treatment-of-a-rare-condition
#9
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...
February 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/27411533/a-novel-surgical-technique-for-bleeding-duodenal-varices-after-failure-of-balloon-occluded-retrograde-transvenous-obliteration-a-case-report
#10
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
https://www.readbyqxmd.com/read/27309571/brto-assisted-endoscopic-histoacryl-injection-in-treating-gastric-varices-with-gastrorenal-shunt
#11
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...
December 2016: Minimally Invasive Therapy & Allied Technologies: MITAT
https://www.readbyqxmd.com/read/27307818/balloon-occluded-retrograde-transvenous-obliteration-of-a-gastrorenal-shunt-using-hydrogel-coated-coil-embolization
#12
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
https://www.readbyqxmd.com/read/27234486/prediction-for-improvement-of-liver-function-after-balloon-occluded-retrograde-transvenous-obliteration-for-gastric-varices-to-manage-portosystemic-shunt-syndrome
#13
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
https://www.readbyqxmd.com/read/27158425/usefulness-of-intra-procedural-cone-beam-computed-tomography-in-modified-balloon-occluded-retrograde-transvenous-obliteration-of-gastric-varices
#14
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
https://www.readbyqxmd.com/read/27054775/update-in-the-management-of-gastric-varices
#15
REVIEW
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
https://www.readbyqxmd.com/read/27049485/management-of-gastroesophageal-varices-in-cirrhotic-patients-current-status-and-future-directions
#16
REVIEW
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
https://www.readbyqxmd.com/read/27048279/a-case-of-liver-cirrhosis-with-bleeding-from-stomal-varices-successfully-treated-using-balloon-occluded-retrograde-transvenous-obliteration
#17
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
https://www.readbyqxmd.com/read/27003222/long-term-outcome-of-154-patients-receiving-balloon-occluded-retrograde-transvenous-obliteration-for-gastric-fundal-varices
#18
Yukinori Imai, Manabu Nakazawa, Satsuki Ando, Kayoko Sugawara, Satoshi Mochida
BACKGROUND AND AIM: This study aims 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 performed 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...
November 2016: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/26992346/novel-endovascular-techniques-to-control-in-outflow-with-dual-approach-for-large-pelvic-arteriovenous-malformation
#19
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
https://www.readbyqxmd.com/read/26966524/simultaneous-combined-balloon-occluded-retrograde-transvenous-obliteration-and-partial-splenic-embolization-for-gastric-fundal-varices
#20
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
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