Radiologic variations in gastrorenal shunts and collateral veins from gastric varices in images obtained before balloon-occluded retrograde transvenous obliteration

To investigate variations in the features of gastrorenal shunts and collateral veins shown by balloon-occluded retrograde venography (B-RTV) and by superior mesenteric and celiac arteriography. A retrospective analysis was performed of the variation in these features on B-RTV and arteriography images obtained from 130 patients who have undergone these studies prior to balloon-occluded retrograde transvenous obliteration at our hospital since 1993. At least one gastrorenal shunt was revealed in 97% (126/130) of cases. Types of gastrorenal shunts observed were as follows: only one main gastrorenal shunt, 94% (118/126) of cases; two main gastrorenal shunts with a ring-like appearance, 3% (4/126); and some gastrorenal shunts to the left renal vein, 3% (4/126). Collateral veins detected were as follows: left inferior phrenic vein, 75% (95/126) of cases; pericardiacophrenic vein, 40% (50/126); gonadal vein, 13% (16/126); retroperitoneal veins, 65% (82/126). It is very important to know the exact configuration of any gastrorenal shunts in order to guide advancement of the balloon catheter into the shunt and to avoid unexpected injection of the sclerosing agent.