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The femoral approach is recommended for catheterization of the gastrorenal shunt for BRTO when the shunt joins the renal vein within 3.5 cm from the IVC.
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In each of the four failures, the alternative approach resulted in obtaining a successful BRTO. The ISD was >3.5 cm in two patients with failed initial femoral approach and < 3.5 cm in two other patients with failed initial jugular approach. Two patients were having both proximal gastrorenal and distal splenorenal shunts. The IVC to shunt distance (ISD) was between 2.0 and 3.5 cm in 13 patients and >3.5 cm in five. In all patients, the inferior vena cava (IVC) to shunt distance (ISD) was measured on the reformatted coronal computed tomography image. There were four failed shunt catheterizations with the femoral or jugular approach two each. In two patients, both femoral and jugular approaches were used. Sixteen patients had undergone BRTO for variceal bleeding (11 cases) and encephalopathy (5 cases) with the femoral (13) and jugular approach (5).
#Coil assisted retrograde transvenous obliteration how to
Why and how to decide whether femoral or jugular approach should be used for shunt catheterization for a successful balloon-occluded retrograde transvenous obliteration (BRTO) procedure.