Advertisement

CardioVascular and Interventional Radiology

, Volume 20, Issue 2, pp 120–124 | Cite as

Embolization of portal-systemic shunts in cirrhotic patients with chronic recurrent hepatic encephalopathy

  • Shin Sakurabayashi
  • Shuichi Sezai
  • Yoshihiro Yamamoto
  • Masanori Hirano
  • Hiroshi Oka
Clinical Investigations

Abstract

Purpose

To evaluate the efficacy of embolization of portal-systemic shunts in cirrhotic patients with chronic recurrent hepatic encephalopathy (CRHE).

Methods

Seven cirrhotic patients with CRHE refractory to medical treatment (3 men and 4 women, mean age 66 years) were studied. Five patients had splenorenal shunts, 1 had a gastrorenal shunt, and 1 had an intrahepatic portal vein-hepatic vein shunt. Shunt embolization was performed using stainless steel coils, with a percutaneous transhepatic portal vein approach in 4 patients and a transrenal vein approach in 3 patients.

Results

After embolization, the shunt disappeared in 4 patients on either ultrasound pulsed Doppler monitoring or portography. Complications observed in the 7 patients were fever, transient pleural effusion, ascites, and mild esophageal varices. For 3–6 months after embolization, the 4 patients whose shunts disappeared showed minimal or no reappearance of a shunt, and had no recurrence of encephalopathy. The serum ammonia levels decreased and electroencephalograms also improved. One of the 4 patients, who developed mild esophageal varices, required no treatment. Treatment was effective in 3 of the 4 patients (75%) who underwent embolization via a transhepatic portal vein.

Conclusion

Transvascular embolization of shunts improved the outcome in 4 of 7 patients. The most effective embolization was achieved via the percutaneous transhepatic portal vein approach.

Key words

Hepatic encephalopathy Liver cirrhosis Portal-systemic shunt Embolization 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hanna SS, Smith RS, Henderson JM, Millikan WJ Jr, Warren WD (1981) Reversal of hepatic encephalopathy after occlusion of total portosystemic shunts. Am J Surg 142:285–289PubMedCrossRefGoogle Scholar
  2. 2.
    Chandler JG, Fechner RE (1983) Hepatopetal flow restoration in patients intolerant of portal diversion. Ann Surg 197:574–583PubMedCrossRefGoogle Scholar
  3. 3.
    Suzuki T, Takasaki K, Watayo T, Tsugita M, Aruga A, Miyazaki S, Katsura K, Otsubo T, Nakagami T, Kobayashi S, Hanyu F, Saito A, Obata Y (1991) Hepatic encephalopathy due to a portosystemic shunt with reverse circulation in the portal tract: A case report. (in Japanese). Acta Hepatol Jpn 132:730–734Google Scholar
  4. 4.
    Potts JR, Henderson JM, Millikan WJ Jr, Sones P, Warren WD (1984) Restoration of portal venous perfusion and reversal of encephalopathy by balloon occlusion of portal systemic shunt. Gastroenterology 87:208–212PubMedGoogle Scholar
  5. 5.
    Ruff RJ, Chuang VP, Alspaugh JP, Casarella WJ, Tuten TU, Gaylord GM (1987) Percutaneous vascular intervention after surgical shunting for portal hypertension. Radiology 164:469–474PubMedGoogle Scholar
  6. 6.
    Uflacker R, Silva AO, Carneiro d’Albuquerque LA, Piske RL, Mourao GS (1987) Chronic portal-systemic encephalopathy: Embolization of portosystemic shunts. Radiology 165:721–725PubMedGoogle Scholar
  7. 7.
    Koyama H, Saitoh M, Sai S, Tsunoda T, Satoh S, Ohto M (1990) A case of portal-systemic encephalopathy with a large gastrorenal shunt in a patient with chronic hepatitis: Percutaneous transhepatic shunt embolization. (in Japanese) Acta Hepatol Jpn 31:694–698Google Scholar
  8. 8.
    Yoshimitsu K, Andou H, Kudo S, Matsuo Y, Matsumoto S, Nakao T, Shimoda Y (1993) Multiple intrahepatic portosystemic shunts: Treatment by portal vein embolization. Cardiovasc Intervent Radiol 16:49–51PubMedCrossRefGoogle Scholar
  9. 9.
    Maeda T, Mori H, Aikawa H, Komatsu E, Kagawa K (1993) Therapeutic embolization of intrahepatic portosystemic shunts by retrograde transcaval catheterization. Cardiovasc Intervent Radiol 16:245–247PubMedCrossRefGoogle Scholar
  10. 10.
    Vavasseur D, Duvoux C, Cherqui D, Derhy S, Rahmouni A, Dhumeaux D, Mathieu D (1994) Chronic hepatic encephalopathy due to spontaneous splenorenal shunt: Successful treatment by transhepatic shunt embolization. Cardiovasc Intervent Radiol 17:298–300PubMedCrossRefGoogle Scholar
  11. 11.
    Japanese Research Society for Portal Hypertension (1991) The general rules for recording endoscopic findings on esophageal-gastric varices. (in Japanese). Acta Hepatol Jpn 35:277–281Google Scholar
  12. 12.
    Ohnishi K, Nakayama T, Koen H, Saito M, Saito M, Chin N, Takebayashi H, Iida S, Nomura F, Okuda K, Takayasu K (1985) Interrelationship between type of spontaneous portal systemic shunt and portal vein pressure in patients with liver disease. Am J Gastroenterol 80:561–564PubMedGoogle Scholar
  13. 13.
    Okuda K, Suzuki K, Musha H, Arimizu N (1977) Percutaneous transhepatic catheterization of the portal vein for the study of portal hemodynamics and shunts: A preliminary report. Gastroenterology 73:279–284PubMedGoogle Scholar
  14. 14.
    Sherlock S (1989) Hepatic encephalopathy. In: Disease of the Liver and Biliary System, 8th edn. Blackwell Scientific, Oxford, pp 95–115Google Scholar
  15. 15.
    Sakurabayashi S (1993) Portal hemodynamics in cirrhotic patients with chronic recurrent encephalopathy. (in Japanese). Acta Hepatol Jpn 34:874–881Google Scholar
  16. 16.
    Ohnishi K, Sato M, Koen H, Nakayama T, Nomura F, Okada K (1985) Pulsed Doppler flow as a criterion of portal venous velocity: Comparison with cineangiographic measurements. Radiology 154:495–498PubMedGoogle Scholar
  17. 17.
    Seo N, Ishiyama S, Katagiri S, Iizawa H, Fuse A, Yoshimura N, Kawamura H, Adachi K, Kameyama J, Tsukamoto M (1986) A case of portal-systemic encephalopathy: Changes in portal circulation by shunt closure using a balloon catheter. (in Japanese) Nippon Rinsyou Geka Igakkai Zasshi 47:1329–1333Google Scholar

Copyright information

© Springer-Verlag New York Inc 1997

Authors and Affiliations

  • Shin Sakurabayashi
    • 1
  • Shuichi Sezai
    • 1
  • Yoshihiro Yamamoto
    • 1
  • Masanori Hirano
    • 1
  • Hiroshi Oka
    • 1
  1. 1.Division of GastroenterologyTokyo Metropolitan Police HospitalTokyoJapan

Personalised recommendations