Intercostal Vein Approach for Balloon-occluded Retrograde Transvenous Obliteration of Gastric Varices: A Case Report

Isolated gastric varices are often treated with retrograde transvenous obliteration through a gastrorenal shunt. However, treatment is challenging when major shunts are absent. We report a rare case of balloon-occluded retrograde transvenous obliteration performed through an intercostal vein. In a 48-year-old man with idiopathic portal hypertension, recurrent isolated gastric varices developed after previous endoscopic and embolization treatments. Imaging indicated the left gastric vein as the inflow vessel and the left 9th intercostal vein as drainage route. Under ultrasound-guided puncture of the intercostal vein, microballoon-occluded retrograde venography was performed, followed by ethanolamine oleate infusion and N-butyl cyanoacrylate embolization. The varix achieved thrombosis without complications. This case highlights the feasibility of intercostal vein access for retrograde transvenous obliteration when conventional routes are unavailable.