# N-Butyl-2-Cyanoacrylate-Assisted Balloon-Occluded Retrograde Transvenous Obliteration (NARTO) of Gastric Varices and Splenorenal Shunts

## TL;DR

NARTO is a safe and effective technique for treating gastric varices and splenorenal shunts without major complications or recurrence.

## Contribution

NARTO introduces a novel embolization method using nBCA without leaving a balloon catheter in place.

## Key findings

- NARTO was technically successful in all 16 patients with no major complications.
- Follow-up imaging showed no recurrence of gastric varices after treatment.
- NARTO improved portal steal syndrome and hepatic encephalopathy in patients with splenorenal shunts.

## Abstract

This retrospective study investigated the efficacy of n-butyl-2-cyanoacrylate (nBCA)-assisted balloon-occluded retrograde transvenous obliteration (NARTO) of gastric varices and splenorenal shunts.

Between November 2021 and February 2024, 16 patients (3 females, 13 males) underwent NARTO, consisting of balloon-occluded retrograde transvenous obliteration (BRTO) followed by nBCA embolization of the efferent draining vein without the balloon catheter remaining indwelling afterward, to treat gastric varices in 12 patients with liver cirrhosis or to improve portal vein flow or hepatic encephalopathy in four patients with splenorenal shunts after liver transplantation.

NARTO was technically successful in all 16 patients without major procedure-related complications. There was no migration of nBCA nor adhesion of nBCA to the balloon catheter. Follow-up contrast-enhanced CT showed no recurrence of gastric varices. For splenorenal shunts after liver transplantation, portal steal syndrome and hepatic encephalopathy improved after NARTO.

NARTO is a simple and efficient technique to occlude gastric varices and portosystemic shunts, avoiding the need for the indwelling of a balloon catheter after injecting the sclerosant.