Balloon-occluded retrograde transvenous obliteration (BRTO)
What is BRTO?
One of the most dire complications of chronic liver disease is Portal hypertension , which results in one of the life threatening complications associated with the disease , in the form of gastric variceal bleeding.
. Gastric variceal bleeding describes the bleeding that occurs when dilated vessels in the stomach rupture, and is associated with high morbidity and mortality rates. BRTO is a minimally invasive technique which involves blocking the dilated vessels, reducing the risk of rupture
Large porto systemic shunts at times can also cause symptoms of hepatic encephalopathy . these symptoms can also be alleviated by this procedure .
How does the procedure work?
The procedure is performed under local anesthesia, via a femoral venous puncture , following which access is gained into the culprit shunt (most commonly being leinorenal cv// ] ` , flexible tube with a tiny balloon at one end) through a vein in your thigh or neck and guide the catheter to the liver using fluoroscopy for guidance. The catheter is then directed to the gastrorenal or gastrocaval shunt and the balloon is expanded to block the shunt.
The interventional radiologist will then perform a venography, which is a type of imaging technique in which X-rays are used to see the vessels clearly. This will allow the interventional radiologist to confirm exactly which vessels need to be treated and if there are any other abnormal or dilated vessels which have not previously been identified. A medication will then be injected into the dilated vessels through the catheter, until they are completely filled. This medication will remain in the vessel for a short period of time, and will then be removed under fluoroscopy.
Another venography will then be performed, to confirm that the blood flow in the shunt has stopped. Finally, the balloon will be deflated and the interventional radiologist will withdraw the catheter.
