Balloon-Occluded Retrograde Transvenous Obliteration

Treatment for:

Gastric varices, hepatic encephalopathy, portal hypertension

Why it’s done:

Patients with liver disease often suffer from high pressure in the portal venous system. The high pressure can result in enlargement of collateral veins which offload the elevated pressure. These veins are often within the lining of the stomach (gastric varices) or lead from the spleen to the veins draining the kidney (splenorenal shunt). The gastric varices are often thin-walled and fragile, and can lead to life-threatening bleeding in the stomach. A splenorenal shunt, or other portosystemic shunts, allow portal venous blood to bypass the filtering effect of the liver, allowing toxins to pass to the brain and cause confusion (hepatic encephalopathy). Blocking these varices or shunts can abolish the risk of bleeding and reduce confusion.

How it’s done:

An interventional radiologist begins by accessing a vein in the neck or groin. A catheter is maneuvered into the enlarged collateral vein(s) draining the portal venous system, and the collateral veins (varices or shunts) are blocked using coils, gelfoam, or other agents.

Level of anesthesia:

Conscious sedation or general anesthesia

Risks:

Bleeding, infection, liver failure, worsening ascites

Post-procedure:

Patients are admitted for observation for 2-3 days, and post-procedure CT is typically performed to confirm occlusion of the varices/shunts.

Follow-up:

In IR clinic every 6 months to confirm continued occlusion and adequate control of symptoms.

For More Information:

For more information or to schedule an appointment with one of our IR physicians, please call 310-481-7545.