Interventional Radiology: Transjugular Retrograde Obliteration
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The method of transvenous retrograde obliteration is divided into two approaches. One is the transjugular approach and the other is the transfemoral approach. The former is called transjugular retrograde obliteration (TJO) and the latter balloon-occluded retrograde transvenous obliteration (B-RTO). TJO makes it easier than B-RTO to reach gastric varices with gastrorenal shunt (GRS) with either superselective or selective access. The gastric varices are successfully eradicated by TJO. However, TJO obliterates the GRS, which has an abundant blood flow and increased portal venous pressure. Partial splenic embolization (PSE) has the effect of decreasing splenic blood flow and portal venous pressure. The combined therapy using TJO and PSE for gastric varices is more effective than TJO only in the long-term prevention of esophageal varices after TJO.
KeywordsTransjugular retrograde obliteration Partial splenic embolization Gastric varices Gastrorenal shunt
I thank Dr. Niranjan Sharma PhD, Mornington Health Centre, Dunedin, New Zealand, for his helpful comments.
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