![]() significant efferent collateral vessels are embolized using coils, and/or gelfoam and sclerosant.occlusive balloon is inflated to occlude the shunt, then contrast injected upstream of the occlusion (retrograde venography) to further evaluate variceal anatomy and identify major collateral vessels. ![]() the target shunt (typically gastro-renal shunt via left renal vein) catheterized using with selective catheter (e.g.a 6 to 12-French vascular sheath placed.systemic venous access obtained via femoral vein approach, alternatively via internal jugular vein approach.The classic BRTO procedure is as follows: afferent & efferent gastric variceal anatomy.CT imaging - ideally immediately preceding BRTO intervention.standard laboratory studies, including liver enzymes and coagulation panel.The techniques employed are typically adapted depending on specific portosystemic anatomy and operator experience and preference. ![]()
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