Ruptured high flow gastric varices with an intratumoral arterioportal shunt treated with balloon-occluded retrograde transvenous obliteration during temporary balloon occlusion of a hepatic artery

Figure 1 Celiac arteriography showing a marked arterioportal shunt with tumorous thread and streak sign and massive reverse flow to the main trunk of the portal vein.

Figure 2 CT during proper hepatic arteriography showing tumor thrombi (arrow) in the right portal vein (A) and gastric varices (arrowhead) (B).

Figure 3 BRTO combined with temporary balloon occlusion of the hepatic artery. A: Proper hepatic arteriography through the balloon catheter during balloon occlusion (arrow); B: Balloon-occluded retrograde venography (arrow) after embolization of the left inferior phrenic vein and the retroperitoneal vein with micro-spring coils (arrowheads) showing the stagnant gastrorenal shunt and gastric varices. A 5% ethanolamine oleate mixture (30 mL) was then injected during dual balloon occlusion.

Figure 4 Contrast-enhanced CT showing thrombosed gastric varices (white arrow) on the following day.