Purpose: To evaluate the feasibility for balloon-occluded retrograde transvenous obliteration (BRTO) for gastric varices without gastrorenal shunts.
Materials and methods: Of 76 patients with gastric varices who were referred for treatment by BRTO, 11 did not have gastrorenal shunts. Contrast medium-enhanced computed tomography (CT) was performed in all patients; seven patients also underwent CT during splenic arteriography. BRTO was performed to insert a balloon catheter into the main draining vein and inject 5% ethanolamine oleate into gastric varices under the temporary balloon occlusion.
Results: The main draining veins were the subphrenic transverse part of the inferior phrenic vein to the inferior vena cava in five patients, the pericardial vein to the left brachiocephalic vein in two, and the paraesophageal vein to the azygos vein in two. In two patients, the main draining vein was unknown. The overall success rate of BRTO in the nine cases with main draining veins was 67%; BRTO was successful in four of the patients in whom the inferior phrenic vein was the main draining vein, one of the patients in whom the pericardial vein was the main draining vein, and one of the patients in whom the paraesophageal vein was the main draining vein. In the other cases in which the inferior phrenic vein or pericardial vein was the main draining vein, BRTO could not be performed because of extravasation. In another patient in whom the paraesophageal vein was the main draining vein, the main draining pathway could not be identified at angiography because of a complicated azygos venous network.
Conclusions: It is feasible to use BRTO to treat cases of gastric varices in which the inferior phrenic vein is the main draining vein. Cases in which the main draining pathway is the pericardial vein are less feasibile for BRTO. The use of BRTO in cases in which the paraesophageal vein is the main draining vein is possible but may be difficult because of a complicated venous network.