Balloon-occluded Retrograde Trans-venous Obliteration (BRTO)
Date issued: November 2024
For review: November 2026
Ref: B-519/LD/Radiology/Balloon-occluded Retrograde (BRTO)
PDF: Balloon-occluded Retrograde (BRTO).pdf [pdf] 233KB
This leaflet tells you about having a Balloon-occluded Retrograde Trans-venous Obliteration (BRTO). It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. You will be referred to an Interventional Radiologist for this procedure. Interventional Radiologists are doctors who have trained and specialised in imaging and x-ray treatments.
Before the procedure you will need to sign a consent form, if one hasn’t been previously completed. This form says that you need to know what risks are involved. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or Radiologist, you do not want this examination, then you can decide against it. If the Radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary, then they will explain this to you and communicate with the referring clinician. You will return to your referring clinician for review.
At all times the Radiologist and referring clinician will be acting in your best interests.
Balloon-occluded Retrograde Trans-venous Obliteration (BRTO)
Balloon-occluded retrograde trans-venous obliteration (BRTO) is a minimally invasive procedure used to treat gastric (stomach) varices. Varices are stretched (dilated) blood vessels. Gastric varices are caused by increased pressure in the liver in patients with liver disease. The increased pressure may cause the blood vessels to burst (rupture) and bleed. BRTO is a procedure that involves blocking the dilated vessels in order to lower the risk of rupture and bleeding.
Why do you need a BRTO?
Patients with liver disease can have complications, such as bleeding from distended veins (varices) in the gullet due to an increase in the blood pressure in the portal vein. The BRTO procedure treats these complications by stopping the blood from the portal vein going to varices.
The doctors looking after you will have been treating your varices by other means. They have decided these other methods of treatment are no longer effective and the best treatment for you now is a BRTO.
Are there any risks?
You may have some bleeding or get an infection. We will give you antibiotics before the procedure to help prevent infection. You may have fever and flu-like symptoms including nausea, vomiting, and pain. This is a normal part of the process the body goes through after this type of procedure. In rare cases, the blockage of blood to the gastric varices can further increase the pressure on the liver. A rare complication is a clot (embolus) can form in the lungs, and this will be treated with aspiration (retrieving the clot) and blood thinners.
Some complications can be life threatening and although rare, death should also be considered as a risk of this procedure.
Are you required to make any special preparations?
Because this procedure can take some time, and occasionally can be painful, Radiologists
prefer you to have a general anaesthetic (GA). There are small risks associated with this which will be explained to you by your anaesthetist.
If you have a morning appointment, you will be asked to have nothing to eat from midnight although you may still drink water up to 6am then sips of water for the 2 hours before your examination.
If you have an afternoon appointment you may eat normally up to 6am and then water only up to 10am with sips of water for the 2 hours before your examination.
If your blood clotting is abnormal, you may be given special blood transfusions to try and correct this. If you have any concerns about having blood transfusions, you should discuss these with your doctor.
If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
Who will you see?
A specially trained team led by an Interventional Radiologist within the radiology department. Interventional radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
If you are having the procedure as a day case, then you will attend the hepatology ward beforehand. You will be asked to get undressed and put on a hospital gown. A small cannula (thin tube) will be placed into a vein in your arm. You may require a fluid drip to help your kidney function before the procedure. Our porters will collect you and bring you to the interventional radiology suite which is located within X-ray East. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during a BRTO?
The catheter is guided to the veins between the left kidney and the stomach via the vein in your groin (occasionally the neck). Once the catheter is in place, a plug will be placed in the vein, or a balloon will be inflated to block blood flow. A medicine is injected through the tube into the dilated vessels which will cause the veins to become blocked. The doctor will make sure that blood flow to the affected vessels has stopped. Then the balloon will be deflated, and the catheter will be removed. The procedure usually takes 2 to 4 hours plus 4 hours for the medicine to work.
Will it hurt?
At the end of the procedure, once you are awake, you may be sore at the side of your groin or neck, but this will resolve over a few days.
How long will it take?
Every patient is different, and it is not always easy to predict; however, expect to be in the radiology department for about two to four hours.
What happens afterwards?
You will be taken back to theatre recovery for a couple of hours and then back to your ward. Nurses will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no problems.
Other Risks
BRTO is a safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency
Finally
Some of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact
Interventional Radiology Department
01752 432063 – Bookings Clerk
01752 430838 – IR Co-ordinator
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (1/1A/42C/34) run from the George Junction Park and Ride Mon-Sat (except Bank Holidays) every 15/20 mins from 6am. The last bus leaves the hospital at 11:30pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact The Patient Transport Service:
Devon GP: 0345 155 1009
Cornwall GP: 01872 252211
