Coil-Assisted Retrograde Transvenous Obliteration: A Valid Treatment for Gastric Variceal Hemorrhage and Hepatic Encephalopathy

Abstract

AbstractCoil-assisted retrograde transvenous obliteration (CARTO) has evolved as a simpler and perhaps safer alternative to balloon-occluded retrograde transvenous obliteration (BRTO). The efficacy of BRTO has been established, and early data supports the use of CARTO in similar situations. In a small series of patients with gastric variceal hemorrhage treated with CARTO, complete portosystemic shunt occlusion, complete variceal obliteration, and no rebleeding during the follow-up period were observed in all patients. In a larger, unpublished study, an improvement in hepatic encephalopathy was observed in over 80% of patients treated with CARTO. In addition, overall liver function was markedly improved in 1 month. As for complications, new or worsened ascites and esophageal varices were observed in 24% and 30%, respectively. Overall, CARTO is an effective treatment of gastric variceal hemorrhage and hepatic encephalopathy with high technical and clinical success rates. Compared with plug-assisted retrograde transvenous obliteration (PARTO), CARTO can be used to safely close larger shunts with a comparable efficacy and complication profiles.