Balloon-occluded Retrograde Transvenous Obliteration for Gastric Varices Draining into the Gastrocaval Shunt.

The left inferior phrenic vein has two orifices and consists of transverse and vertical parts. A total of 10%-15% of fundal gastric varices drain into the gastrocaval shunt, a hypertrophied transverse part of the left inferior phrenic vein. The outlet of the gastrocaval shunt is occasionally kinked and stenotic, and the transverse part of the left inferior phrenic vein is usually connected to several vessels. Additionally, portopulmonary venous anastomosis is occasionally accompanied by gastric varices draining into the gastrocaval shunt without developing a gastrorenal shunt. These anatomical characteristics make it difficult to embolize gastric varices draining into the gastrocaval shunt with balloon-occluded retrograde transvenous obliteration. We describe fundamental techniques for catheterizing and obliterating gastric varices draining into the gastrocaval shunt using 5% ethanolamine oleate.