Fig. Gastric varices supplied by multiple gastric veins
Schematic drawing of the hemodynamic change after balloon occlusion of the drainage shunt.
Before balloon occlusion of the shunt, blood from all gastric veins drained through the varices into the drainage vein. Note that the left gastric vein suppies both gastric vein and the esophageal（paraesophageal）varices. When the drainage vein is occluded with a balloon, left gastric vein and esophageal paraesophageal varices can work as a draining vein because they communicate with the systemic vein of azygos venous system and the pressure of the left gastric vein would be lower than that of other gastric veins. Therefore, sclerotic agent injected via the balloon catheter would be drained into the esophageal varices through the left gastric vein, and so it does not fill in the high pressure portion of the varices.
上からb, c,
Fig. Temporary balloon occlusion of the splenic artery with balloon during B-RTO
b : MIP image of postcontrast CT shows a large gastric varices（GV）which is supplied by multiple gastric veins. Note the left gastric vein（LGV）supply to the gastric varices and also to paraesophageal varices（paraEV）. SGV（short gastric vein）, PGV（posterior gastric vein）.
c : We perform balloon occlusion of the gastrorenal shunt and advance a microcatheter into the varices. Balloon occluded venography of the gastric varices shows the contrast material washed out via the left gastric vein and the paraesophageal varices（arrows）