“Downgrading” of Gastric Varices with Multiple Collateral Veins in Balloon-occluded Retrograde Transvenous Obliteration

The efficacy of a “downgrading” method for treatment of gastric varices (GVs) was evaluated in 15 patients who had undergone balloon-occluded retrograde transvenous obliteration (B-RTO) of GVs with multiple collateral veins. Downgrading in this study was meant to transform high-grade GVs into GVs with a low-grade architecture more amenable to treatment. Success was defined as gastrorenal shunt occlusion at the proximal site with a 6-F balloon catheter advanced over a microcatheter and without opacification of large collateral vessels. Thirteen of 15 patients with grade 3/4 GVs had their GVs successfully downgraded. The procedure is thought to be safe and effective in the initial B-RTO procedure.