Health

Is percutaneous transhepatic biliary drainage (PTBD) the most appropriate initial method to treat biliary obstruction?  The selection of the most appropriate modality (percutaneous, endoscopic, or surgical) to provide biliary drainage depends on the interventional options available, the location and extent of the obstructing lesion, and the expertise of the operator. Currently, endoscopic drainage is the …

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How is the HVPG measured?  Access into the hepatic veins can be obtained via the more common transjugular approach or via a transfemoral approach. A balloon occlusion catheter is placed into a hepatic vein 2 to 3 cm from the hepatic vein ostium and a free hepatic vein pressure (FHVP) measurement is obtained with the …

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What are the specific indications for transjugular liver biopsy? Coagulopathy Need for hepatic venous pressure gradient (HVPG) Massive obesity Ascites Ascites is often listed as an indication for transjugular liver biopsy and a contraindication for percutaneous liver biopsy. However, several studies have demonstrated no significant difference in minor or major complication rates with percutaneous liver …

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Postprocedurally what condition can BRTO aggravate?  Portal hypertension can increase after BRTO. As a result of increased portal hypertension, there can be aggravation of nongastric (esophageal or duodenal) varices, development of portal hypertensive gastropathy, ascites, and hydrothorax or pleural effusion.

When might BRTO rather than TIPS be indicated to treat gastric varices?  BRTO is indicated in patients with a large gastrorenal or gastrocaval shunt who have hepatic encephalopathy, poor hepatic reserve, or a low portal pressure. With TIPS, portal flow is diverted away from the liver and through the shunt; thus there is a risk …

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Most common portosystemic shunt occluded during a BRTO procedure  A gastrorenal shunt is the most common type to be occluded during a BRTO procedure because a gastrorenal shunt provides venous outflow in 90% of gastric varices cases with the remaining 10% draining via a gastrocaval shunt.

Balloon occluded retrograde transvenous obliteration (BRTO) BRTO is an endovascular technique used as a therapeutic adjunct or alternative to TIPS in the management of gastric varices. It involves the use of occlusion balloons to occlude the outflow veins of a portosystemic shunt and endovascular injection of a sclerosing agent directly into the varix. BRTO is …

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