Plug-Assisted Retrograde Transvenous Obliteration: A Modified Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices

Gastric varices (GVs) and hepatic encephalopathy (HE) are major complications of portal hypertension in patients with liver cirrhosis. As most of the GVs drain into the left renal vein via a portosystemic shunt, the concept of retrograde treatment approach such as balloon-occluded retrograde transvenous obliteration using sclerosing agents has been introduced. Recently, plug-assisted retrograde transvenous obliteration (PARTO) has been alternatively performed, which uses vascular plug and gelfoam. PARTO utilizes a permanent vascular plug to reduce postprocedural monitoring time as well as to avoid the risk of balloon rupture–related complications. It also eliminates the sclerosing agents–related complications with the use of gelfoam as an embolics. In this review, we introduce technical aspects of PARTO and outline its potential for use as the treatment of GVs and HE.