Selective balloon-occluded retrograde transvenous obliteration of gastric varix with preservation of major portacaval shunt.

1All authors: Department of Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-bu, Osaka, Japan 545-8585. Address correspondence to N. Nishida (norifumin@med.osakacu.ac.jp). alloon-occluded retrograde transvenous obliteration (B-RTO) has been performed instead of endoscopic and surgical treatment in the management of gastric varix. The procedure is indicated for gastric varix with a major portacaval shunt, such as a gastrorenal shunt or a shunt involving the left inferior phrenic vein, and usually obliterates the gastric varix and the connecting major portacaval shunt. BRTO is safe, feasible, and effective in the treatment of patients with gastric varix; however, aggravation of esophageal varix is an important complication caused by increasing portal pressure [1–3]. We report the first case, to our knowledge, of selective B-RTO with preservation of the major portacaval shunt. MDCT during splenic and superior mesenteric arterial portography was useful for confirming the morphologic features and developing a precise therapeutic plan.