Emergency balloon-occluded retrograde transvenous obliteration of ruptured gastric varices

Figure 1 Gastric varices with a gastrorenal shunt (case 15). A: Balloon-occluded retrograde transvenous obliteration (BRTO) was performed 11 h after hematemesis. The gastric varices and a gastrorenal shunt were filled with 36 mL of 5% ethanolamine oleate iopamidol. A Sengstaken–Blakemore tube was inserted into the stomach for temporary hemostasis; B: Contrast-enhanced computed tomography (CE-CT) image taken before BRTO shows gastric varices (arrowhead) with a massive hematoma; C: CE-CT image taken 1 wk after BRTO shows complete thrombosis of the varices (arrowhead); D: CE-CT image taken 6 mo after BRTO shows complete disappearance of the varices; E: Endoscopy performed before BRTO shows gastric varices (arrowhead) with oozing; F: Endoscopy performed 6 mo after BRTO shows complete disappearance of the varices.

Figure 2 Gastric varices with a gastrocaval shunt (case 8). A: A balloon catheter was inserted into a gastrocaval shunt and 18 mL of 5% EOI was injected through the microcatheter that had been advanced close to the gastric varices; B: Contrast-enhanced computed tomography (CE-CT) image taken before balloon-occluded retrograde transvenous obliteration (BRTO) shows gastric varices (arrowhead) with a massive hematoma; C: CE-CT image taken the day after BRTO shows complete thrombosis of the varices (arrowhead) and that the tip of the microcatheter (arrow) is close to the varices; D: Endoscopy performed before BRTO shows bleeding site (arrow) of the gastric varices (arrowhead); E: Endoscopy performed 3 mo after BRTO shows complete disappearance of the varices.