BRTO自1996年在日本以及全世界各地作为经导管治疗孤立性胃静脉曲张得到广泛的认可，因为有益的治疗效果已经被证实。
2. 适应症（Indications）
A. 主要适应症（main indications） (1) 胃静脉曲张破裂出血的紧急情况和胃静脉曲张破裂历史或胃肾分流有破裂的风险 (2) 由于胃肾分流导致的肝性脑病的情况 B. 相对适应症 （Relative indications） (1) 由于门腔静脉分流，如肠系膜-腔静脉分流等导致肝性脑病 (2) 由于门静脉高压如十二指肠静脉曲张和肠系膜静脉曲张出血 C. 相对禁忌症（Relative contraindication: ） 造影剂流很容易从分流进入门静脉 BRTO和胃静脉曲张的血流动力学（Hemodynamics of gastric varices and BRTO）: 胃食管静脉曲张的供应途径是左胃静脉和短/后胃静脉。前者是食管静脉曲张的主要途径，后者是胃静脉曲张的主要途径。注入胃后壁静脉曲张的血液从膈下静脉经肾上腺静脉下降流入肾静脉。这就是所谓的胃肾分流（GR分流）。另一方面，来自上方的血流经心包隔静脉加入胃底静脉曲张，同时有注入左肝静脉上方的下腔静脉。
5. Complications: Hematuria frequently appears, but it rarely leads to renal failure when haptoglobin is concomitantly used. Pulmonary embolism may occur, so balloon occlusion for long time is essential. Abdominal pain immediately after ethanol injection occurs very frequently, so analgesics are necessary.
6. Conclusions: B- RTO is used to embolize the varices from downstream, in contrast to PTO, which embolizes the varices from upstream. B- RTO can be employed not only for gastric varices but also for duodenal varices and mesocaval shunt. Our results showed very excellent effects for gastric varices, suggesting the first choice of treatment for GV. In many cases, the portal blood flow becomes hepatopetal again, and half of the patients that underwent B- RTO showed a secondary effect of improvement in liver function, revealing that B- RTO has a therapeutic effect on liver cirrhosis.
References
1. Hirota S, Matsumoto S, Tomita M et. al. Retrograde Transvenous Obliteration of Gastric Varices. Radiology 1999; 211: 349-356.
2. Fukuda T, Hirota S, Sugimura K. Long- term results of balloon- occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy. J vasc Interv Radiol 12: 327-336, 2001.
3. Hirota S, Ichikawa S, Matsumoto S et. al. Interventional Radiologic Treatment for Idiopathic Portal Hypertension. Cardiovasc Intervent Radiol. 1999; 22: 311-314.
4. Fukuda T, Hirota S, Sugimoto K, Matsumoto S, Zamora CA, Sugimura K. “Downgrading” of gastric varices with multiple collateral veins in balloon- occluded retrograde transvenous obliteration. J Vasc Interv Radiol.2005 16(10):1379-83, 2005.
5. Hirota S, Kobayashi K, Maeda H, Yamamoto S, Nakao N. Balloon- occluded retrograde transvenous obliteration for portal hypertension, Radiation Medicine, in print.
6. Maeda H, Hirota S, Yamamoto S, Kobayashi K, Arai K, Miyamoto Y, Fukuda T, Sugimoto K, Nakao N. Outflow patterns of gastrointestinal shunts and collateral veins from gastric varices: Radiologic variations and relevance to balloon- occluded retrograde transvenous obliteration, CVIR, 2007 May- Jun;30(3):410-4.
Learning Objective
1. To learn how and when to do BRTO
2. To learn the technique of BRTO
3. To present recent trials and meta- analysis of the technique
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