Balloon-occluded retrograde transvenous obliteration of gastric varices: conception, evolution, and history.

The idea of transvenous obliteration of varices that complicate portal hypertension dates back to the 1970s. The clinical use of this minimally invasive procedure was probably lost with the advent of transjugular intrahepatic portosystemic shunt shortly afterward. The concept of retrograde obliteration of a gastrorenal shunt through the left renal vein originated from Olson et al at Indiana University. However, the Japanese (Kanagawa et al and subsequent authors) defined, developed, and technically perfected the clinical implementation of balloon-occluded retrograde transvenous obliteration. The evolution of balloon-occluded retrograde transvenous obliteration has come full circle, now gaining popularity in the United States, especially in patients who are not candidates for transjugular intrahepatic portosystemic shunt.