Abstract
A 43-year-old woman with alcoholic liver cirrhosis was hospitalized with gastric varices, which brought about transient bleeding 1 week ago. Enhanced CT and esophago-gastro duodenoscopy revealed gastric fundal varices with some gastrorenal shunt. Balloon-occluded retrograde transvenous obliteration (B-RTO) was offered as the treatment. A 6.0-Fr balloon was introduced from the right internal jugular vein into the gastro-renal shunt. However, the main gastro-renal shunt could not completely blocked with a 6.0-Fr balloon catheter because another small shunt that branched from the gastro-renal shunt developed and drained the blood flow into the left renal vein.
Therefore, a 6.0-Fr catheter was introduced from the right femoral vein to left renal vein and 3.2Fr balloon catheter was inserted into the 6.0-Fr catheter and positioned in the small gastrorenal shunt described above. Inflation of the two balloons resulted in occlusion of the both gastrorenal shunts. After occulusion of these shunts, B-RTO was performed. One-week after the treatment, follow-up CT scans revealed thrombosed gastric varices. Simultaneously blocking of the branched gastro-renal shunt occluded successfully the blood flow into the renal vein, resulting in complete sclerosis of fundal gastric varices.
