Balloon-occluded retrograde transvenous obliteration for treatment of gastric varices

Figure 3 Schema of balloon-occluded retrograde transvenous obliteration modified variants. A: In plug-assisted retrograde transvenous obliteration, a vascular plug is placed instead of a balloon catheter to block shunt blood flow. In the original method, gelatin sponge suspension is injected instead of sclerosant; B: In coil-assisted retrograde transvenous obliteration (CARTO), shunt blood flow is blocked using microcoils and gelatin sponge suspension is injected to embolize the gastric varices; C: In modified CARTO, instead of downgrading by advancing the balloon catheter, embolization is performed using microcoils and sclerosant is injected upstream into the gastric varices; D: In CARTO-II, sclerosant is injected from a balloon catheter in the same manner as conventional balloon-occluded retrograde transvenous obliteration, coil embolization is performed just above the balloon, and the balloon catheter is finally removed.