1. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices 
Barbara M. Ryan, Reinhold W. Stockbrugger, J.Mark Ryan 
Gastroenterology 
Volume 126, Issue 4, Pages (April 2004)
DOI: /j.gastro

2. Figure 1 Classification of GV. From Sarin et al.8 with permission.
Gastroenterology  , DOI: ( /j.gastro )

3. Figure 2
(A ) Normal portal venous blood flow. PV, portal vein; CoV, coronary vein; SpV, splenic vein; SMV, superior mesenteric vein. (B) Portal venous blood flow in the presence of portal hypertension and GRS. Note reversal of flow in the coronary vein resulting in esophageal varices, and reversal of flow in the splenic vein resulting in gastric varices, which decompress via the GRS. Lkid, left kidney; LRV, left renal vein; IVC, inferior vena cava.
Gastroenterology  , DOI: ( /j.gastro )

4. Figure 3
(A) Transhepatic splenic venogram shows filling of GV and stenosis (St) of the splenic vein (SP). The pressure gradient across the stenosis was 16 mm Hg. (B) Splenic venogram after stent placement (ST) across the stenosis. The pressure gradient was reduced to 2 mm Hg. The gastric varices no longer fill readily.
Gastroenterology  , DOI: ( /j.gastro )

5. Figure 4
(A ) Early-phase portogram of a patient with increased velocities (and turbulence) on Doppler ultrasound shows stenosis of the TIPS (TS) secondary to pseudo-intimal hyperplasia. There is also early filling of EV and GV owing to hepatofugal flow in the coronary vein (C) and splenic vein (SV), respectively. Hepatic vein PPG was 12 mm Hg. (B) Late-phase portogram shows marked filling of the esophageal varices (E) and gastric varices (G). The TIPS stent (T) is well seen. (C ) Very late phase portogram shows GV draining via a spontaneous GRS into the left renal vein (RV). (D) Early-phase portogram postangioplasty of the stenotic TIPS shows resolution of the stenosis (T). Early filling of the EV and GV still are seen. Hepatic vein PPG was 11 mm Hg.
Gastroenterology  , DOI: ( /j.gastro )

6. Figure 5
(A) B-RTO. The left renal vein is cannulated via a transjugular or a transfemoral approach. A balloon catheter is inserted and inflated for 30 minutes in the GRS, blocking the main outflow of the varix. Sclerosant (5% ethanolamine oleate mixed with a contrast agent such as iopamidol) then is injected slowly and directly into the varices in a retrograde manner until the GV are filled completely with contrast (controlled fluoroscopically). (B) Balloon-occluded endoscopic injection sclerotherapy. The portal vein is cannulated transhepatically and, if present, a GRS is cannulated transfemorally via the left renal vein. Via the portal vein, the smaller veins supplying the varices are occluded with coils and the main supplying vein also is occluded with a balloon, essentially creating a closed circuit. Endoscopically the varices then are injected with sclerosant. Posttreatment, the catheters remain in situ for 24 hours to permit maximal sclerosis of the varices. G.varix, gastric varix; S.g.vein, short gastric vein; R.g.vein, right gastric vein; L.g.vein, left gastric vein; GR shunt, gastrorenal shunt. Reprinted from Shiba et al.157 with permission.
Gastroenterology  , DOI: ( /j.gastro )

7. Figure 6
Proposed algorithm for management of bleeding gastric varices. BO-EIS, balloon-occluded endoscopic injection sclerotherapy.
Gastroenterology  , DOI: ( /j.gastro )