Figure 4

B-RTO performed on a 49-year-old man with alcohol-related liver cirrhosis. A CT scan obtained during arterioportography showed gastric fundal varices. B. Bleeding of the gastric varices occurred before the scheduled B-RTO procedure, and endoscopic injection sclerotherapy (EIS) using cyanoacrylate was performed as an emergency procedure to control the bleeding. A plain CT scan obtained after EIS showed that the sclerosing agent was almost uniformly distributed throughout the network of gastric varices (arrow), except in the gastrorenal shunt. The scheduled B-RTO was cancelled because the bleeding of the gastric varices ceased after the emergency EIS. C. The patient had a history of repeated gastric variceal bleeding and was referred to our department for a B-RTO procedure 4 years after he had received EIS for the first time. The venogram revealed a gastrorenal shunt; however, the gastric varices could not be clearly visualized because the contrast medium had leaked into systemic circulation. D. A retrograde venogram obtained after coil embolization of the inferior phrenic vein (arrow) clearly showed the recurrence of gastric varices (arrowhead). The gastric varices were completely thrombosed after the first B-RTO procedure, as determined by CT during follow-up.