Gastric variceal bleeding results in higher morbidity and mortality compared to esophageal variceal bleeding; furthermore, treatment with endoscopic or portal decompression procedures is associated with a higher risk of rebleeding. Trans-venous variceal obliterative techniques allow direct obliteration of varices with excellent outcomes and include retrograde systemic venous (also known as retrograde transvenous obliteration of varices—RTO) and antegrade portal venous approaches. The RTO approach uses balloons, vascular plugs, or coils to occlude the systemic venous outflow of the varices and facilitate safe embolization of the varices through injection of liquid embolic materials. Obliteration of the physiologic shunt has profound hemodynamic effects, including decreased rebleeding, improved hepatic encephalopathy, and improved hepatic function. The variceal obliterative procedures for the treatment of gastric varices that will be reviewed in this chapter include balloon-occluded retrograde transvenous obliteration (BRTO), plug-assisted retrograde transvenous obliteration (PARTO), coil-assisted retrograde transvenous obliteration (CARTO), and balloon-assisted antegrade transvenous obliteration (BATO).