Portopulmonary venous anastomosis detected at balloon-occluded retrograde transvenous obliteration for gastric varices.

The present report describes three patients with portopulmonary venous anastomosis (PPVA) in whom balloon-occluded retrograde transvenous obliteration (B-RTO) of gastric varices was attempted. No patients had a gastrorenal shunt. In one patient, after an approach from the inferior phrenic vein (IPV), the PPVA was embolized with the use of microcoils. In another patient, after an approach from the IPV, the balloon catheter was advanced to a distal position from the PPVA. B-RTO was performed in these two cases without systemic infarction. In the remaining patient, after an approach from the azygos vein, the balloon catheter was not advanced distally from the PPVA, and therefore sclerotic agents were not infused.