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Evolution of Retrograde Transvenous Obliteration Techniques
Mihir Patel1, Christopher Molvar1
1Department of Interventional Radiology, Loyola University Medical Center, Maywood, Illinois.
Seminars in Interventional Radiology
|August 9, 2018
Summary
Retrograde transvenous obliteration (RTO) offers a less invasive treatment for gastric variceal hemorrhage and hepatic encephalopathy. This evolving technique shows promise with various methods, improving hepatic function but potentially increasing portal pressure.
Area of Science:
- Interventional Radiology
- Hepatology
- Gastroenterology
Background:
- Gastric variceal hemorrhage (GVH) is a severe complication of portal hypertension with high mortality.
- GVH carries a worse prognosis than esophageal variceal hemorrhage.
- Infradiaphragmatic portosystemic shunts, like gastrorenal shunts, enable treatment via retrograde transvenous obliteration (RTO).
Purpose of the Study:
- To review the evolving techniques of retrograde transvenous obliteration (RTO).
- To discuss patient selection criteria for RTO.
- To analyze the technical and clinical outcomes, including adverse events, of RTO for gastric variceal hemorrhage and hepatic encephalopathy.
Main Methods:
- Discussion of various RTO techniques: balloon-assisted, plug-assisted, and coil-assisted.
- Comparison of RTO with transjugular intrahepatic portosystemic shunt (TIPS) creation.
- Review of patient eligibility, procedural details, and outcomes.
Main Results:
- RTO is a less invasive alternative to TIPS, potentially improving hepatic function.
- RTO may lead to an increase in portal pressure.
- The article details technical success rates, clinical efficacy, and safety profiles of different RTO approaches.
Conclusions:
- Retrograde transvenous obliteration (RTO) is a viable and evolving treatment for gastric variceal hemorrhage and hepatic encephalopathy.
- RTO offers benefits in terms of invasiveness and hepatic function preservation compared to TIPS.
- Careful patient selection and understanding of potential adverse events, including increased portal pressure, are crucial for successful RTO outcomes.
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