Balloon-occluded retrograde transvenous obliteration for treatment of gastric varices

Figure 4 Schema of changes in portal hemodynamics due to combined balloon-occluded retrograde transvenous obliteration and partial splenic embolization. A: Before treatment, most of the splenic blood flow is short-circuited to the systemic circulation via the gastrorenal shunt (GRS); B: The GRS is embolized by balloon-occluded retrograde transvenous obliteration (BRTO) (black asterisk). The increase in portal venous flow after BRTO is mainly caused by increased splenic venous blood flow without a substantial increase in hepatopetal mesenteric venous blood flow; C: The lower half of the spleen is infarcted by partial splenic embolization (PSE) (white asterisk). Hepatopetal mesenteric venous blood flow increases after splenic venous blood flow is decreased by PSE. PV: portal vein, SPV: splenic vein, SMV: superior mesenteric vein.