AI Summary BRTO uses a balloon catheter and a sclerosing agent to seal the abnormal veins feeding gastric varices, typically takes 3 to 6 hours, and may require overnight observation.
Medically reviewed.
Balloon-occluded retrograde transvenous obliteration (BRTO) is an interventional radiology procedure that treats gastric varices, which are enlarged veins in the stomach. A doctor guides a catheter with an inflatable balloon to the abnormal vein, blocks the blood flow, and injects a medicine that seals the vein. BRTO lowers the risk of bleeding from gastric varices and helps manage some complications of portal hypertension. Treatment decisions should always be individualized and guided by a healthcare professional.
This page covers BRTO: when it is recommended, how it works, what the procedure involves, benefits, risks, and follow-up care. You can also connect with a liver specialist near you for personalized guidance on whether BRTO fits your care plan.
Liver Health AI Assistant
Ask Aimy
Aimy answers from LiverDirectory’s reviewed health information — helping patients make sense of liver-health terms, prepare for specialist visits, and explore what to look up next.
ABOUT BRTO
BRTO stands for balloon-occluded retrograde transvenous obliteration. It is an interventional radiology procedure. A specialist uses a catheter to reach the abnormal vein that drains blood from gastric varices, enlarged veins in the stomach. The procedure blocks that vein and seals it shut.
Gastric varices can form when pressure rises in the portal vein, the main vein that carries blood to the liver. This is called portal hypertension. Gastric varices can bleed, and the bleeding can be serious.
BRTO treats the varices directly. It does not treat the underlying liver disease. It is one of the portal hypertension procedures, alongside TIPS and paracentesis.
WHO BRTO MAY BE SUITABLE FOR
Your healthcare provider may recommend BRTO if you have gastric varices at risk of bleeding, or if you have already had bleeding from gastric varices. It may also be an option if you are not an ideal candidate for TIPS, or if you have complications related to abnormal portal blood flow.
BRTO is also among the options when endoscopic glue injection is not effective or cannot be used. It is preferred for people who cannot have TIPS, such as those with poor liver function or a history of hepatic encephalopathy. For people who could have either procedure, the choice depends on vein anatomy, overall health, and local expertise.
Every person's veins and liver condition are different. Your care team decides whether BRTO is appropriate after a full assessment.
ELIGIBILITY OVERVIEW
BRTO may be considered for adults with the following conditions, needs, or treatment goals:
Before recommending BRTO, healthcare providers evaluate several factors to decide whether it is an appropriate option, including:
HOW BRTO CAN HELP YOUR LIVER
BRTO works on the abnormal vein that drains blood from gastric varices. The doctor inflates a small balloon in that vein to stop blood flow. A sclerosing agent, a medicine that irritates and seals the vein wall, is then injected into the blocked vein.
Once the vein closes, the varices lose their blood supply. This lowers the risk of bleeding from gastric varices. Blood flow is redirected into healthier circulation pathways.
BRTO targets the varices themselves. It does not lower portal vein pressure the way TIPS does. Procedures like BRTO target variceal vessels directly, and they can be used alone or combined with TIPS.
LIVER BENEFITS
Gastric varices can form when pressure rises in the portal vein, the main vein that carries blood to the liver. They are a complication of portal hypertension. BRTO treats this complication directly, so you and your care team can focus on managing your liver condition.
Once the abnormal vein is closed, the blood that once fed the varices is redirected into healthier circulation pathways. This changes how blood moves around the stomach and liver area, and it is one way BRTO supports your overall portal hypertension care.
BRTO does not treat the underlying liver disease. It works alongside your other care. You will likely keep taking the treatments your team recommends for portal hypertension, avoid alcohol if it applies to you, and follow your dietary recommendations.
After BRTO, follow-up imaging and clinical assessment show whether the vein has closed and the treatment worked. Regular visits also give your care team a chance to review your liver health and adjust your plan.
BRTO seals the abnormal veins that feed gastric varices to lower the risk of bleeding. It supports your liver care by treating a complication of portal hypertension, and it should only be performed and followed by a qualified healthcare team.
TREATMENT PROCESS
Imaging studies are performed to identify the abnormal veins being treated.
A catheter with an inflatable balloon is inserted through a vein, usually in the groin or neck, and guided to the abnormal vein draining the gastric varices. The balloon is inflated to temporarily block blood flow while a sclerosing agent is injected to seal the abnormal vein. The balloon remains in place for several hours to ensure successful vessel closure before being removed.
The procedure typically takes 3 to 6 hours, depending on the complexity of the vein anatomy and the treatment.
You are monitored after the procedure and may need to stay overnight for observation.
Follow-up imaging and clinical assessment are used to check whether the treatment worked.
BENEFITS AND SAFETY
BRTO may help people with gastric varices by lowering the risk of bleeding. It treats the abnormal blood vessels directly and avoids major surgery. It can also help control selected complications of portal hypertension. How much you benefit depends on your veins, your liver function, and your overall health.
BRTO is not a stand-alone answer. You will likely keep taking your other treatments for portal hypertension, and you will need follow-up imaging and visits.
As with any procedure, BRTO has risks. In some people it can worsen esophageal varices, the enlarged veins in the esophagus. Your care team will monitor you for this and other problems after the procedure.
BENEFITS
BRTO reduces the risk of bleeding from gastric varices. Preventing gastric variceal hemorrhage is the main goal of the procedure, whether your varices have not bled yet or have bled before.
BRTO is done through a catheter placed in a vein, usually in the groin or neck, so it avoids major surgery. You are monitored afterward and may need to stay overnight for observation.
BRTO directly treats the abnormal blood vessels that feed gastric varices. It focuses on those vessels rather than on the underlying liver disease, so you will likely keep taking your other recommended treatments.
BRTO helps control selected complications of portal hypertension. It can be an option when TIPS is not a good fit, and your care team decides whether it suits your veins and overall health.
Your healthcare provider will discuss the potential benefits and risks before the procedure and will monitor you afterward with follow-up imaging and clinical assessment.
SUPPORTING YOUR RESULTS
After BRTO, continue the treatments recommended for your portal hypertension. Avoid alcohol if it applies to you, and follow the dietary recommendations from your healthcare team.
Attend your scheduled follow-up appointments. Follow-up imaging and clinical assessment show whether the treatment worked.
Areas that may support treatment:
COMMON QUESTIONS
BRTO is an interventional radiology procedure that treats gastric varices, which are enlarged veins in the stomach. A doctor guides a balloon catheter to the abnormal vein that drains the varices, blocks blood flow, and injects a sclerosing agent to seal the vein. This lowers the risk of bleeding and helps manage some complications of portal hypertension. Ask your healthcare professional whether BRTO fits your situation.
BRTO may be an option if you have gastric varices at risk of bleeding or have already had bleeding from them. It may also be considered if you are not an ideal candidate for TIPS. Your care team weighs your vein anatomy on imaging, your liver function, and any history of complications such as hepatic encephalopathy. Only a healthcare professional can decide whether BRTO is appropriate for you after a full assessment.
The procedure typically takes 3 to 6 hours, depending on the complexity of your vein anatomy. The balloon stays in place for several hours so the vein can close before the balloon is removed. Afterward, your team monitors you, and you may need to stay overnight for observation. Ask your healthcare professional what to expect for your own preparation and recovery.
BRTO can cause side effects. Common risks include abdominal pain, fever, bleeding, and blood clot formation. In some people, BRTO can worsen esophageal varices, which are enlarged veins in the esophagus. Your healthcare provider will discuss the benefits and risks with you before the procedure and monitor you afterward with follow-up imaging and clinical assessment. Talk with your care team about which risks matter most for you.
BRTO is designed to lower the risk of bleeding from gastric varices by sealing the vein that feeds them. Follow-up imaging and clinical assessment are used to check whether the treatment worked. BRTO targets the varices, not the underlying liver disease, so you will likely keep taking your other portal hypertension treatments. Your healthcare professional can explain what results to expect in your case.
BRTO and TIPS are different procedures. BRTO targets the abnormal veins that feed gastric varices. TIPS creates a channel inside the liver that lowers portal vein pressure. BRTO may be an option if you are not an ideal candidate for TIPS. The choice depends on your vein anatomy, liver function, and overall health, so discuss both options with your healthcare professional.
Medical disclaimer: LiverDirectory provides educational information and a directory of providers. It does not provide medical advice, diagnosis, or treatment. Always consult a licensed physician regarding any medical condition.
