NICE has been notified about this procedure and it is part of its work programme. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
 
Status In progress
Decision Selected
Process IP
ID number 1865
Description Cross sectional imaging is done to identify and confirm the target shunt (gastro-renal shunt [GRS] is usually present). Percutaneous venous access of the femoral or jugular vein using standard angiographic technique is performed. An occlusion balloon catheter is inserted and navigated into the target shunt (GRS via left renal vein) under fluoroscopy guidance. The balloon is inflated to occlude the shunt and a venography is then performed to define the variceal anatomy and type of varices. Sclerosant is slowly injected into the varices to fill the full extent of the varices, with the embolisation endpoint being minimal filling of the afferent vein/portal vasculature. The injection of sclerosant can be done with or without the use of a microcatheter for more selective injection. The occlusion balloon catheter is left in situ until the satisfactory embolisation of the varices is achieved. This procedure is called balloon-occluded retrograde transvenous obliteration (BRTO), aiming to obliterate the varices and manage large gastric varices or treat acute gastric variceal haemorrhage. Modified techniques such as balloon-occluded antegrade transvenous obliteration (BATO), vascular plug-assisted retrograde transvenous obliteration (PARTO) and coil-assisted retrograde transvenous obliteration (CARTO), follow a similar procedure to BRTO. However, for PARTO and CARTO, shunt occlusion is permanently achieved by vascular plugging or coiling. These 2 techniques reduce procedure time (length of time the balloon is left indwelling and inflated) and decrease the risk of balloon rupture.

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For further information on how we develop interventional procedures guidance, please see our IP manual