8? 11 Absolute contradictions for TIPS placement are right heart failure, severe pulmonary hypertension, severe tricuspid regurgitation, uncontrolled systemic infection or sepsis, unrelieved biliary obstruction, and liver failure. 8? 11 Furthermore, this procedure is an effective way to treat GV in patients with contraindications for TIPS placement. Several studies have demonstrated that balloon-occluded retrograde transvenous obliteration (BRTO) is effected in the treatment of bleeding isolated GV, which are often associated with spontaneous gastrorenal shunts. 3, 4 Transjugular intrahepatic portosystemic shunts (TIPS) are also widely used in the management of GV however, high-level evidence of its decompressive benefits for isolated GV are lacking and shunting portal blood flow can further compromise liver function and aggravate hepatic encephalopathy. 1, 2 In addition, due to its size, sclerosis of GV often requires a larger volume of sclerosant and creates a higher risk of non-target embolization predominately to the pulmonary system. Esophageal varices (EV) are routinely treated via endoscopic methods however, the long term success of endoscopically treated gastric varices (GV) are limited in part due to high flow through the varix and also the location of the varices in the cardia/gastric fundus. Variceal bleeding is a serious complication of portal hypertension.
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