Balloon Retrograde Transvenous Obliteration for Treatment of Persistent Gastric Variceal Bleed in Patient With Hepatocellular Carcinoma.

Gastric varices are often associated with formation of spontaneous portosystemic shunts that arise to relieve portal hypertension. Balloon retrograde transvenous obliteration (BRTO) is a procedure indicated to prevent recurrent gastric variceal bleeding. Its advantage is diverting blood flow towards the liver, but this can also worsen portal pressure and increase risk for ascites or esophageal variceal bleeding. Patients with gastric varices and concomitant hepatocellular carcinoma (HCC) usually have more advanced cirrhosis and lower possibility of treatment of HCC. BRTO is thought to preserve hepatic function from increased blood flow, possibly allowing better chances of treatment and survival in these patients.