E1864. BRTO - Balloon-occluded Retrograde Transvenous Obliteration of Varices: A Brief Review
  1. Shambo Guha Roy; Mercy Catholic Medical Center
  2. Mousam Dey; Indian Institute of Liver and Digestive Sciences
  3. Amar Mukund; Institute of Liver and Biliary Sciences
Cirrhosis of liver affects more than half million patients in the US. Cirrhosis with portal hypertension can lead to gastro-esophageal and ectopic varices, which caries significant mortality and morbidity. Radiological and endoscopic intervention play an integral role in management of varices. Two radiological procedures which can be performed for varices are tans-jugular intrahepatic porto systemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) with their modifications.

Educational Goals / Teaching Points
In this review we will discuss the role of BRTO in the management of variceal bleed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomy and physiology of variceal bleed Treatment options Patient selection for BRTO– indication and contraindications Equipment Procedural techniques Variations - CARTO and PARTO Illustrations of few cases Complications Follow up BRTO vs TIPS vs Band ligation Future research and unanswered questions

BRTO is an effective treatment for variceal bleed. Though historically not popular in the US, it is getting popular. The radiologists should be aware of which patient to select for the procedure, procedural anatomy, techniques and its complications.