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Semin intervent Radiol 2011; 28(3): 288-295
DOI: 10.1055/s-0031-1284455
© Thieme Medical Publishers

Balloon-occluded Retrograde Transvenous Obliteration (BRTO): Preprocedural Evaluation and Imaging

Abdullah M. S. Al-Osaimi1 , Saher S. Sabri2 , Stephen H. Caldwell1
  • 1Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
  • 2Division of Interventional Radiology, Department of Radiology, University of Virginia Health System, Charlottesville, Virginia
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Publication History

Publication Date:
15 August 2011 (online)

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ABSTRACT

Patients undergoing balloon retrograde transvenous obliteration (BRTO) are mostly decompensated cirrhotic with either bleeding gastric varices (GV) or hepatic encephalopathy. It is crucial that clinicians are up-to-date with the assessments needed prior to BRTO to anticipate and prevent complications, and to deliver critical quality care. These patients will require preprocedural assessments and management, including endoscopic, clinical, laboratory, and imaging evaluation. Endoscopic evaluation is mandatory prior to BRTO, and it is highly recommended that it be performed at the same institution where BRTO will be performed. It is essential that clinicians are aware of the potential benefits and complications that may result from BRTO. These complications should be anticipated and prevented when possible. For GV bleeders, there should be consideration of a transvenous intrahepatic portosystemic shunt (TIPS) during or before BRTO in patients with refractory ascites or pleural effusion, as well as endoscopic banding or a TIPS in patients with high-risk esophageal varices. Patients undergoing BRTO are usually complicated and require a team approach. In this article, the authors address these assessment and preparatory management and planning procedures prior to the BRTO procedure as well as expected outcomes and potential complications.

KEYWORDS

Gastric varices - portal hypertension - liver cirrhosis - BRTO - TIPS - splenorenal shunt

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Abdullah M. S. Al-OsaimiM.D. F.A.C.P. F.A.C.G. A.G.A.F. 

Associate Professor of Medicine and Surgery, Medical Director of Liver Transplantation, Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia Health System

P.O. BOX 800708, Charlottesville, VA 22908-0708

Email: aa6h@virginia.edu