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Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock

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Published on: May 19, 2022

Balloon-occluded retrograde transvenous occlusion.

Hector Ferral¹

¹Department of Radiology, Section of Interventional Radiology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA. hector_ferral@rush.edu

Techniques in Vascular and Interventional Radiology

|June 17, 2009

Summary

This review details managing acute upper gastrointestinal bleeding from gastric varices using balloon-occluded retrograde transvenous occlusion (BORTO). BORTO, a Japanese technique, offers a promising alternative for patients with large gastrosystemic shunts.

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Area of Science:

Interventional Radiology
Gastroenterology
Vascular Medicine

Background:

Acute, massive upper gastrointestinal bleeding is a critical condition.
Isolated gastric varices represent a significant source of gastrointestinal hemorrhage.
Gastric varices often result from large gastrosystemic shunts, complicating management.

Observation:

The case involves a patient with acute, massive upper GI bleeding originating from isolated gastric varices.
The patient presented with a large gastrosystemic shunt, a known risk factor for variceal bleeding.
Management involved a two-step approach: splenic artery embolization followed by BORTO.

Findings:

Balloon-occluded retrograde transvenous occlusion (BORTO) is an effective technique for treating bleeding gastric varices.
BORTO, pioneered in Japan, is utilized as a first-line therapy for gastric variceal management.
This technique has shown potential in managing complex cases involving large gastrosystemic shunts.

Implications:

Introducing and popularizing BORTO in the USA can provide a valuable therapeutic option.
BORTO offers a minimally invasive alternative for patients with bleeding gastric varices.
This approach may improve outcomes and reduce morbidity associated with upper gastrointestinal bleeding.