Balloon-occluded retrograde transvenous obliteration
Medical procedure used to treat gastric varices
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Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular procedure used for the treatment of gastric varices. When performing the procedure, an interventional radiologist accesses blood vessels using a catheter, inflates a balloon (e.g. balloon occlusion) and injects a substance into the variceal blood vessels that causes blockage of those vessels. To prevent the flow of the agent out of the intended site (variceal blood vessels), a balloon is inflated during the procedure, which occludes.
| Balloon-occluded retrograde transvenous obliteration | |
|---|---|
| Other names | BRTO |
| Specialty | Interventional radiology |
Medical uses
BRTO is used for the treatment of bleeding from gastric varices. In addition to transjugular intrahepatic portosystemic shunt (TIPS), BRTO is a first line treatment for the prevention of recurrent bleeding from gastric varices (GOV2 or IGV1).[1] BRTO may be used for the treatment of ectopic varices.[1]
Complications
As BRTO results in a blockage of a portosystemic shunt, the procedure may result in increased portal hypertension, which may worsen esophageal varices or ascites.[2][1]
History
BRTO was developed as a procedure in the early 1990s.[2] Initially, the procedure was performed using ethanolamine oleate as a sclerosant.[2][3] Between 2006 and 2007, American physicians began using sodium tetradecyl sulfate (3% STS) as an alternative sclerosing agent.[2][3]