Abstract
Balloon-occluded retrograde transvenous obliteration (BRTO) is effective in the treatment of gastric varices and hepatic encephalopathy. However, in cases of severe liver dysfunction (Child-Pugh grade C), shunt occlusion leads to an increased risk of liver failure due to portal hypertension. Recent advances in devices such as double-balloon catheters, microcatheters, and embolic agents including n-butyl-2-cyanoacrylate (NBCA) and metallic coils have enabled partial BRTO and multiple-stage BRTO, leading to improved outcome. Strategic treatment planning with preoperative analysis of collateral vascular anatomy by computed tomography (CT) and pressure measurement before occlusion may provide safer and more effective BRTO. For cases of severe liver dysfunction, medical management is the priority of treatment. BRTO is part of a multidisciplinary treatment approach. When performing treatment, a strategy taking into account the long-term prognosis of the patient should be considered.
