Figure 4e. Treatment of a type 3 gastric varix with a combination of BRTO and coil embolization of a direct shunting vein. (a, b) Contrast-enhanced CT scans show small gastric varices (arrow in a) and multiple enlarged gastric veins (arrowheads in b). (c) Splenic venogram (transileocolic venous access) shows the small gastric varices (arrows) to be contiguous with a large gastrorenal shunt. (d) Posterior gastric venogram shows direct communication between the posterior gastric vein and the gastrorenal shunt. (e) Fluoroscopic image obtained during BRTO performed after coil embolization of the direct shunting vein and afferent gastric veins shows sufficient variceal opacification (arrows). Arrowheads indicate coils in the left gastric and posterior gastric veins.