Retrograde Transvenous Obliteration
A treatment for bleeding vessels around the stomach
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What is Retrograde Transvenous Obliteration?
Blood from the organs in the belly flows through the liver, which filters out the nutrients and toxins. Long-term damage to the liver can cause scarring. This scarring is known as cirrhosis. Cirrhosis makes the liver stiff. It is harder for blood to flow through a stiff liver. As the pressure builds, the blood backs up in nearby veins. These veins get stretched out and are called varices. Varices are fragile and can bleed easily. This bleeding can be life-threatening.
One treatment is blocking off the varices to stop them from bleeding. This is called “Retrograde Transvenous Obliteration.” The varices can be blocked off with tiny balloons, metallic coils, or small plugs with similar results.
How is Retrograde Transvenous Obliteration done?
You will be given medications to keep you comfortable. The clinician numbs the skin then slides a small tube into a large vein in your neck or at the top of the thigh. They use moving x-rays to guide the tube through the veins and to the varices. The clinician then blocks the blood flow to the varices using a balloon, coils or a plug. Special material is injected into the blocked varices to shut them down. The clinician then removes the tube and puts a bandage over the pinhole in the skin.
Retrograde Transvenous Obliteration
1. The clinician slides a small tube into a large vein in the neck or at the top of the thigh.
2. They guide the tube to the varices and then block them using a balloon, coils or a plug.
3. Special material is injected into the blocked varices to shut them down.
What are the risks?
Retrograde Transvenous Obliteration (RTO) is generally a safe procedure when done by a specialist
Pain, fever, and blood in the urine are not uncommon after RTO and usually get better on their own.
Complications are rare. They include internal bleeding, buildup of fluid in the belly or around the lungs, infection, damage to the kidneys from medications used during the procedure, and damage to the stomach or other nearby structures.
1-7 in 100 people may have the varices bleed again.
What are the alternatives?
Alternative 1 Not treating the varices. The advantage is that you avoid a procedure. However, the varices put you at risk of serious internal bleeding. Bleeding varices is one of the most common causes of death in people with cirrhosis.
Alternative 2 Medicines can help with other symptoms of liver disease. Unfortunately, they are not as good at reducing the risk of bleeding for varices in the stomach.
Alternative 3 TIPS. A tunnel is made between two veins in the liver to relieve the backed-up pressure and reduce bleeding. When done alone, it only prevents bleeding from varices around the stomach in about 1 in 2 people. Sometimes it is done with a RTO.
Alternative 4 Endoscopy. Stomach varices can also be treated by passing a small camera (or “endoscope”) down your throat. The varices are then injected with material to make them clot from within your stomach. This treatment is less effective at preventing bleeding as compared to RTO or TIPS.