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Treatment / Retrograde Transvenous Obliteration of Gastric Varices (BRTO) / (PARTO)

Retrograde Transvenous Obliteration of Gastric Varices (BRTO)/(PARTO)

Portal hypertension refers to high blood pressure in the liver. One of the major complications of portal hypertension is gastric variceal bleeding. Varices are dilated vessels which may rupture, causing variceal bleeding. BRTO stands for balloon-occluded retrograde transvenous obliteration. BRTO is performed for patients with bleeding related to gastric varices.

Am I a Candidate for BRTO?

When you come in to be treated for gastric varices, your doctor will talk to you about your medical history and perform diagnostic testing, which may include an MRI or CAT scan. Once it is determined that you are a good candidate for the procedure the next step is to schedule treatment.

Candidates are patients that present with or are at risk for the following:

  • Bleeding from large veins in the stomach
  • Worsening of brain function due to a damaged liver (encephalopathy)
  • Narrowing of portosystemic shunts

BRTO is a safe procedure that can preserve liver function by blocking blood from the left renal vein to the enlarged veins around the stomach

What to Expect from the Procedure

When you come in for your procedure, you will either have local anesthesia with sedation, or general anesthesia – whatever you and your vascular and interventional radiologist (VIR) have discussed. The doctor will insert a thin, flexible tube with a tiny balloon on one end through a vein in your thigh or neck. Using image guidance, the catheter will be directed to the veins between the left kidney and the stomach. The balloon will then be inflated to prevent leakage of the sclerosing agent. Sclerosing agents are irritating chemicals that are inserted into the vein that causes the vein to become inflamed leading to scar tissue that blocks the opening. Then, the sclerosing agent and/or coils are placed to block the blood supply to the vein.

Once x-rays confirm that the embolization has been successful the balloon will be deflated and removed.


Typically the procedure will require an overnight stay in the hospital. If you have no signs of bleeding from the stomach, you should be able to go home the next day.

Procedure-related complications are minor and include bleeding and infection. In rare cases, the blockage of the blood to the varices can further increase the pressure on the liver, causing damage.

Whether or not you are a candidate for BRTO will depend on your diagnosis and consultation with your interventional radiologist. But if you suffer from gastric varices this minimally invasive procedure could help prevent or reduce the number of life-threatening bleeds. Call IVC today at 503-612-0498 for more information or to schedule a consultation.

* This information about Retrograde Transvenous Obliteration of Gastric Varices was reviewed by Dr. Jason R. Bauer. If you have any questions, please don’t hesitate to contact us using the form below.

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We are announcing that Interventional and Vascular Consultants will be closing as of March 10, 2023.

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Jason Bauer, MD RVT
Michael Pfister, MD RVT

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