Abstract
Ethanolamine oleate (EO; Oldamine®) is the approved sclerosing agent for BRTO in Japan, but the drawback of EO is that its upper limit of use is 0.4 mL/kg or 30 mL as 5% ethanolamine oleate iopamidol (EOI). With large varices, the upper limit of sclerosing agent permitted may be insufficient for obliteration. Even with small varices, if there are many drainage veins, embolization with coils is difficult, and there is leakage throughout the systemic circulation, it is expected that the upper limit of sclerosing agent will be insufficient. To solve these problems, stepwise injections have been used to inject small amounts of sclerosing agent, coil embolization of the drainage veins is performed, and additional glucose solution is injected. However, there are still some difficult cases. We have been treating patients with a mixture of a small amount of gelatin sponge particles and 5% EOI for retrograde transvenous obliteration (GERTO). This is a very good treatment that reduces the systemic release of the sclerosing agent while also shortening the treatment time.
