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Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices with Gastrorenal Shunt: Long-Term Follow-Up in 78 Patients

Teruhisa Ninoi1, Norifumi Nishida1, Toshio Kaminou2, Yukimasa Sakai1, Toshiaki Kitayama1, Masao Hamuro1, Ryusaku Yamada1, Kenji Nakamura1, Tetsuo Arakawa3 and Yuichi Inoue1

1 Department of Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
2 Department of Radiology, Faculty of Medicine, Tottori University, Yonago, Japan.
3 Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan.



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  		Fig. 1A. —Balloon-occluded retrograde transvenous obliteration (B-RTO) in 58-year-old man with alcohol-related liver cirrhosis. Schematic shows B-RTO procedure.

 


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  		Fig. 1B. —Balloon-occluded retrograde transvenous obliteration (B-RTO) in 58-year-old man with alcohol-related liver cirrhosis. Balloon-occluded retrograde transvenous venogram shows that gastric varices are not visualized due to leakage of contrast medium into systemic circulation.

 


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  		Fig. 1C. —Balloon-occluded retrograde transvenous obliteration (B-RTO) in 58-year-old man with alcohol-related liver cirrhosis. Retrograde venogram obtained after coil embolization of inferior phrenic vein shows that gastric varices are clearly visualized and retention of contrast medium in gastric varices is sufficient to inject sclerosing agent.

 


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  		Fig. 1D. —Balloon-occluded retrograde transvenous obliteration (B-RTO) in 58-year-old man with alcohol-related liver cirrhosis. Contrast-enhanced CT scan obtained before B-RTO shows that gastric varices have blood flow.

 


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  		Fig. 1E. —Balloon-occluded retrograde transvenous obliteration (B-RTO) in 58-year-old man with alcohol-related liver cirrhosis. Contrast-enhanced CT scan obtained 2 weeks after B-RTO shows that gastric varices are completely thrombosed.

 


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  		Fig. 2A. —Cumulative recurrence and bleeding of gastric varices after balloon-occluded retrograde transvenous obliteration (B-RTO). Graph shows cumulative recurrence of gastric varices (GV).

 


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  		Fig. 2B. —Cumulative recurrence and bleeding of gastric varices after balloon-occluded retrograde transvenous obliteration (B-RTO). Graph shows cumulative bleeding of gastric varices (GV).

 


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  		Fig. 3A. —Cumulative worsening of esophageal varices (EV) after balloon-occluded retrograde transvenous obliteration (B-RTO). Graph shows overall worsening of esophageal varices.

 


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  		Fig. 3B. —Cumulative worsening of esophageal varices (EV) after balloon-occluded retrograde transvenous obliteration (B-RTO). Graph shows patients with esophageal varices versus those without them.

 


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  		Fig. 4A. —Cumulative survival after balloon-occluded retrograde transvenous obliteration (B-RTO). Graph shows survival of patients with B-RTO.

 


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  		Fig. 4B. —Cumulative survival after balloon-occluded retrograde transvenous obliteration (B-RTO). Graph shows patients with hepatocellular carcinoma (HCC) versus those without HCC.

 


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  		Fig. 4C. —Cumulative survival after balloon-occluded retrograde transvenous obliteration (B-RTO). Graph shows Child-Pugh class A versus B and C.

 

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