Fig. 3

Selective BRTO technique. a Oblique volume rendering (VR) image obtained from pre-BRTO CE-CT portal phase images shows gastric varices (GV) supplied from short gastric vein (SGV) and drained by gastrorenal shunt (GRS). b The same oblique VR image in a but after subtraction of the feeding SGV, splenic vein (Sp.V), and portal vein (PV) to clearly visualize the direct connection between the other SGV and the proximal part of GRS (hollow white arrow) and the direct connection between left gastric vein (LGV) and the distal part of GRS very near to GV (arrowhead). c DSA image during retrograde venography of the GRS shows the connection between SGV and the proximal GRS (hollow white arrow). d DSA during balloon occluded retrograde venography of GRS shows partial visualization of GV with contrast reflux through the direct connection of LGV with the distal GRS (EAEDC) toward portal vein (PV). e Selective venography within the LGV EAEDC after successful catheterization of the EAEDC using microcatheter (black arrow) for EAEDC coiling to prevent EOI reflux into the PV. f Fluoroscopic image at the end of BRTO shows balloon catheter (hollow white arrow) positioned at the middle part of the GRS above the level of SGV EAEDC while LGV EAEDC was coiled (black arrow) with total opacification of the distal part of GRS and GV with EOI