Emergency Plug-assisted Retrograde Transvenous Obliteration Using an Optimo 9-Fr Balloon Guiding Catheter: A Case Report.

Gastric variceal rupture requires rapid hemostasis. When an abdominal balloon catheter is unavailable, alternatives are needed. We report emergency plug-assisted retrograde transvenous obliteration performed with a 9-Fr Optimo balloon-guiding catheter in a 59-year-old man with alcoholic cirrhosis and fundal gastric varices. Under balloon occlusion, balloon-occluded retrograde transvenous venography delineated the variceal complex. A 10-mm Amplatzer Vascular Plug II was deployed via the Optimo, followed by stepwise injection of gelatin sponge particles through a high-flow microcatheter. Complete occlusion was achieved without complications. Follow-up computed tomography and endoscopy confirmed improvement. The Optimo enabled single-system balloon-occluded retrograde transvenous venography, plug deployment, and embolic delivery through one venous access, offering a practical option for urgent hemostasis when inventory constraints exist, provided that preprocedural computed tomography confirms device compatibility.