Balloon-Occluded Retrograde Transvenous Obliteration
21-gauge needle under real-time ultrasound guidance.
After placing a transitional dilator, a 10 French 30 cm sheath was placed.
The left renal vein was then selected with a Lev catheter.
An 8 Fr angled guiding sheath was advanced into the proximal left renal vein.
The gastrorenal shunt was catheterized using a 5 Fr angled glide catheter and a glidewire. A small amount of contrast was injected to confirm adequate positioning. The sheath was then advanced into the gastrorenal shunt. A microcatheter was advanced through the guiding sheath and positioned in the superior aspect of the gastroduodenal renal shunt. Alongside the microcatheter , a 12 mm Amplatzer plug was advanced through the sheath and placed within the inferior aspect of the shunt. Inferior phrenic and adjacent collaterals were coil embolized using a combination of 2mm and 3mm micronester coils. Embolization of the gastrorenal shunt via the microcatheter was then using a combination of 2 air: 2 Sotradecol : 1 Lipiodol. The Amplatzer plug was then detached. A venogram from the left renal vein confirmed positioning of embolization material.