Plug-Assisted Retrograde Transvenous Obliteration (PARTO): Anatomical Factors Determining Procedure Outcome
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TECHNICAL NOTE
VENOUS INTERVENTIONS
Plug-Assisted Retrograde Transvenous Obliteration (PARTO): Anatomical Factors Determining Procedure Outcome Amar Mukund1 • Karan Manoj Anandpara1 • Ravindran Ramalingam1 Ashok Choudhury2 • Shiv Kumar Sarin2
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Received: 10 April 2020 / Accepted: 26 June 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Purpose To study various anatomical factors determining procedure success versus failure for plug-assisted retrograde transvenous obliteration (PARTO) of gastro-lienorenal shunt. Materials and Methods A retrospective review of 50 patients (M:F-37:13; mean age 58.4yrs) who were planned for PARTO of gastro-lieno-renal shunt from July 2017 to July 2019 was done. Anatomical factors [shunt diameter, shunt angle, shunt orientation, left renal vein (LRV) size/calibre and distance of shunt from renal vein-IVC confluence] were analysed on a pre-procedure CT. Statistical analysis of the data was done to assess the relationship between these factors and technical success/failure.
Amar Mukund and Karan Manoj Anandpara contributed equally to this work. & Amar Mukund [email protected] Karan Manoj Anandpara [email protected]
Results PARTO was successfully performed in 82% (n = 41). Analysis of anatomical factors showed that aneurysmal dilatation of the LRV, extreme acute/obtuse angulation and extreme antero-posterior orientation of the shunt in relation to the LRV was associated with higher probability of technical failure of PARTO. Minimum/maximum and entry point shunt diameter was not associated with procedure outcome. It was also noted that an increased distance of the shunt from the renal vein-IVC confluence favoured trans-jugular over trans-femoral venous access for PARTO. Conclusion Knowledge of various anatomical factors of gastro-lieno-renal shunt may help in deciding the access route for PARTO and may determine technical success/failure. Alternate methods like BRTO or coil-assisted obliteration (CARTO) or anterograde obliteration of the shunt via trans-hepatic/splenic route might be needed in such circumstances. Keywords Plug-assisted retrograde transvenous obliteration (PARTO) Portal hypertension Hepatobiliary intervention Porto-systemic shunt
Ravindran Ramalingam [email protected] Ashok Choudhury [email protected] Shiv Kumar Sarin [email protected] 1
Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India
2
Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, , New Delhi 110070, India
Introduction Major sequelae of portal hypertension are esophagogastric variceal bleeding and type-B bypass hepatic encephalopathy due to collateral pathways [1–4]. Traditionally, balloon-occluded retrograde transvenous obliteration (BRTO) has been used to obliterate such shunts/varices [5–13].
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A. Mukund et al.: Plug-Assisted Retrograde Transv
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