Great #DistanceMedEd about Mx of Variceal bleeding from @TedWJamesMD and thanks for this invite!
TIPS, BRTO and BATO - 🤦♀️Too many puzzling acronyms?
Lets break this down for you from #Irad perspective with a #Tweetorial
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TIPS, BRTO and BATO - 🤦♀️Too many puzzling acronyms?
Lets break this down for you from #Irad perspective with a #Tweetorial
1/
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TIPS: basic overview of variceal anatomy and flow dynamics ( will help understanding BATO and BRTO later)
Normal Liver: hepatopedal flow
Cirrhotic Liver: hepatofugal flow
TIPS: Restored hepatopedal flow
TIPS: basic overview of variceal anatomy and flow dynamics ( will help understanding BATO and BRTO later)
Normal Liver: hepatopedal flow
Cirrhotic Liver: hepatofugal flow
TIPS: Restored hepatopedal flow
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TIPS performed since 1982, but whats 🔥 ?
Contraindications ⬇️ with time. Why? Newer #Irad techniques
TIPS now possible in chronic Portal vein thrombosis, specially relevant as these patients not transplant eligible
High technical success, 39% underwent transplantation
TIPS performed since 1982, but whats 🔥 ?
Contraindications ⬇️ with time. Why? Newer #Irad techniques
TIPS now possible in chronic Portal vein thrombosis, specially relevant as these patients not transplant eligible
High technical success, 39% underwent transplantation
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TIPS 🔥
In a RCT of 'Early TIPS' vs standard treatment for acute variceal bleeding, TIPS significantly improved transplantation free survival
Does this call for a change in practice pattern?
Early TIPS?
TIPS 🔥
In a RCT of 'Early TIPS' vs standard treatment for acute variceal bleeding, TIPS significantly improved transplantation free survival
Does this call for a change in practice pattern?
Early TIPS?
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Remember when-
You struggled to stop bleeding from Isolated Gastric Varices?
Uncontrolled bleeding esophageal varices that cannot get TIPS due to high MELD >18?
Severe HE that cannot be controlled with meds?
Enter🏃BRTO and BATO....
Remember when-
You struggled to stop bleeding from Isolated Gastric Varices?
Uncontrolled bleeding esophageal varices that cannot get TIPS due to high MELD >18?
Severe HE that cannot be controlled with meds?
Enter🏃BRTO and BATO....
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BRTO and BATO are essentially the same method of shutting down varices by injecting a foam sclerosant ( sorta similar to endoscopic, but from within vessels)
A balloon is placed to prevent reflux of sclerosant into normal veins
Technically easy, low Mortality, Morbidity
BRTO and BATO are essentially the same method of shutting down varices by injecting a foam sclerosant ( sorta similar to endoscopic, but from within vessels)
A balloon is placed to prevent reflux of sclerosant into normal veins
Technically easy, low Mortality, Morbidity
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So what is difference between the-more common- B(R)TO and B(A)TO?
Its just the #Irad approach:
A- Antegrade- Into the varices from Portal venous side- Thru TIPS or Transhepatic liver
R- Retrograde- Into the varices from systemic side-Thru Femoral vein
So what is difference between the-more common- B(R)TO and B(A)TO?
Its just the #Irad approach:
A- Antegrade- Into the varices from Portal venous side- Thru TIPS or Transhepatic liver
R- Retrograde- Into the varices from systemic side-Thru Femoral vein
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Overview of Venous anatomy and flow:
Important to recognize afferent (in blue)and efferent vein ( yellow- called a Spleno renal shunt).
BRTO cannot be performed without a shunt. A CT scan with contrast is best for planning BRTO.
Overview of Venous anatomy and flow:
Important to recognize afferent (in blue)and efferent vein ( yellow- called a Spleno renal shunt).
BRTO cannot be performed without a shunt. A CT scan with contrast is best for planning BRTO.
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Another important indication for BRTO is in treating HE refractory to medical treatment, with or without a TIPS.
The presence of a large spleno renal shunt takes blood flow into the systemic circulation.
BRTO can actually treat this!
Another important indication for BRTO is in treating HE refractory to medical treatment, with or without a TIPS.
The presence of a large spleno renal shunt takes blood flow into the systemic circulation.
BRTO can actually treat this!
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BRTO has few (relative)contraindications:
Splenic or Portal vein thrombosis
Ascites
Uncontrolled esophageal variceal bleeding: Consider TIPS + BRTO or trans-TIPS BATO
BRTO has few (relative)contraindications:
Splenic or Portal vein thrombosis
Ascites
Uncontrolled esophageal variceal bleeding: Consider TIPS + BRTO or trans-TIPS BATO
