Skip to main content

Advertisement

SpringerLink
Log in

Closing spontaneous portosystemic shunts in cirrhosis: Does it make sense? Does it work? What does it take?

  • Review Article
  • Published:
Metabolic Brain Disease Aims and scope Submit manuscript

Abstract

Spontaneous portosystemic shunts (SPSS) are an often neglected cause of hepatic encephalopathy associated with cirrhosis. Nowadays, SPSS are considered as radiological biomarkers of clinically significant portal hypertension rather than the previous dogmatic perceived decompressive vessels. SPSS are not rare as they can be diagnosed in over 60% of the patients with cirrhosis by mere contrast-enhanced CT. Moreover, they are clinically relevant since they impact on all portal hypertensive related complications, in particular medically refractory HE, and represent an independent predictor of decompensation and mortality in cirrhosis, irrespective of the type of SPSS. Taken together, these elements warrant strategies to target these shunts directly which is currently is achieved via interventional radiology embolization. In this review, we discuss why it makes sense to tackle SPSS, how to do it and what it takes to do it right based on aggregated literature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability statement

Not applicable since this involves a review article.

References

  • Aller MA, Arias J (2006) Portal systemic collateral development: is it a trophic adaption mechanism to hepatic deprivation. J Gastroenterol Hepatol 21:1643–1645. https://doi.org/10.1111/j.1440-1746.2006.04508.x

    Article  PubMed  Google Scholar 

  • An J, Kim KW, Han S, Lee J, Lim YS (2014) Improvement in survival associated with embolization of spontaneous portosystemic shunt in patients with recurrent hepatic encephalopathy. Aliment Pharmacol Ther 39(12):1418–1426. https://doi.org/10.1111/apt.12771

    Article  CAS  PubMed  Google Scholar 

  • Bajaj JS, Reddy KR, Tandon P, Wong F, Kamath PS, Garcia-Tsao G, Maliakkal B, Biggins SW, Thuluvath PJ, Fallon MB, Subramanian RM, Vargas H, Thacker LR, O’Leary JG, North American Consortium for the Study of End-Stage Liver Disease (2016) The 3-month readmission rate remains unacceptably high in a large North American cohort of patients with cirrhosis. Hepatology 64(1):200–8. https://doi.org/10.1002/hep.28414

    Article  PubMed  Google Scholar 

  • Berzigotti A, Merkel C, Magalotti D, Tiani C, Gaiani S, Sacerdoti D, Zoli M (2008) New abdominal collaterals at ultrasound: a clue of progression of portal hypertension. Dig Liver Dis 40(1):62–67. https://doi.org/10.1016/j.dld.2007.08.011

    Article  CAS  PubMed  Google Scholar 

  • Boixadera H, Tomasello H, Quiroga S, Cordoba J, Perez M, Segarra A (2010) Successful embolization of a spontaneous mesocaval shunt using the Amplatzer Vascular Plug II. Cardiovasc Intervent Radiol 33:1044–1048

    Article  PubMed  Google Scholar 

  • Cordoba J, Mínguez B (2008) Hepatic Encephalopathy. Semin Liv Dis 28(1):70–80. https://doi.org/10.1055/s-2008-1040322

    Article  Google Scholar 

  • Dajti E, Renzulli M, Colecchia A, Bacchi-Reggiani ML, Milandri M, Rossini B, Ravaioli F, Marasco G, Alemanni LV, Ierardi AM, Carrafiello G, Pinzani M, Azzaroli F, Mazzella G, Golfieri R, Festi D (2022) Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients. Dig Liver Dis 54(1):103–110. https://doi.org/10.1016/j.dld.2020.12.114

    Article  PubMed  Google Scholar 

  • de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C, Faculty BVII (2022) BAVENO VII – renewing consensus in portal hypertension. J Hepatol 76(4):959–974. https://doi.org/10.1016/j.jhep.2021.12.022

    Article  PubMed  Google Scholar 

  • Di Pascoli M, Ceranto E, De Nardi P, Donato D, Gatta A, Angeli P, Pontisso P (2017) Hospitalizations due to cirrhosis: clinical aspects in a large cohort of Italian patiens and cost analysis report. Dig Dis 35(5):433–438. https://doi.org/10.1159/000458722

    Article  PubMed  Google Scholar 

  • Dömland M, Gebel M, Caselitz M, Bleck J (2000) Manns MP (1980) Comparison of portal venous flow in cirrhotic patients with and without paraumbilical vein patency using duplexsonography. Ultraschall Med Stuttg Ger 21:165–169. https://doi.org/10.1055/s-2000-6928

    Article  Google Scholar 

  • EASL Clinical Practice Guidelines on the management of decompensated cirrhosis (2018) J Hepatol 69(2):406–460. https://doi.org/10.1016/j.jhep.2018.03.024.

  • EASL Clinical Practice Guidelines on the management of hepatic encephalopathy (2022) J Hepatol S0168–8278(22)00346–4. https://doi.org/10.1016/j.jhep.2022.06.001

  • Fukuda T, Hirota S, Sugimura K (2001) Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy. J Vasc Interv Radiol 12:327–336

    Article  CAS  PubMed  Google Scholar 

  • Gu W, Hortlik H, Erasmus HP, Schaaf L, Zeleke Y, Uschner FE, Ferstl P, Schulz M, Peiffer KH, Queck A, Sauerbruch T, Brol MJ, Rohde G, Sanchez C, Moreau R, Arroyo V, Zeuzem S, Welsch C, Trebicka J (2021) Trends and the course of liver cirrhosis and its complications in Germany: nationwide population-based study (2005–2018). Lancet Reg Health Eur 12:100240. https://doi.org/10.1016/j.lanepe.2021.100240 (eCollection 2022 Jan)

    Article  PubMed  PubMed Central  Google Scholar 

  • Henderson JM (1989) Treatment portal systemic encephalopathy by embolization of the shunt. Hepatology 9:164–165

    Article  CAS  PubMed  Google Scholar 

  • Jepsen P, Ott P, Andersen PK, Sorensen HT, Vilstrup H (2010) Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology 51:1657–1682

    Article  Google Scholar 

  • Kako Y, Yamakado K, Jomoto W, Nasada T, Asada K, Takaki H, Kobayashi K, Daimon T, Hirota S (2017) Changes in liver perfusion and function before and after percutaneous occlusion of spontaneous portosystemic shunt. Jpn J Radiol 35(7):366–372. https://doi.org/10.1007/s11604-017-0647-6

    Article  PubMed  Google Scholar 

  • Karlsen TH, Sheron N, Zelber-Sagi S, Carrieri P, Dusheiko G, Bugianesi E, Pryke R, Hutchinson SJ, Sangro B, Martin NK, Cecchini M, Dirac MA, Belloni A, Serra-Burriel M, Ponsioen CY, Sheena B, Lerouge A, Devaux M, Scott N, Hellard M, Verkade HJ, Sturm E, Marchesini G, Yki-Järvinen H, Byrne CD, Targher G, Tur-Sinai A, Barrett D, Ninburg M, Reic T, Taylor A, Rhodes T, Treloar C, Petersen C, Schramm C, Flisiak R, Simonova MY, Pares A, Johnson P, Cucchetti A, Graupera I, Lionis C, Pose E, Fabrellas N, Ma AT, Mendive JM, Mazzaferro V, Rutter H, Cortez-Pinto H, Kelly D, Burton R, Lazarus JV, Ginès P, Buti M, Newsome PN, Burra P, Manns MP (2022) The EASL-Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. Lancet 399(10319):61–116. https://doi.org/10.1016/S0140-6736(21)01701-3

    Article  PubMed  Google Scholar 

  • Kato K, Kondo S, Hirano S, Omi M, Ambo Y, Okushiba S, Katoh H (2001) Surgical closure of the gastrorenal shunt with distal splenorenal shunt operation for portosystemic encephalopathy. Hepatogastroenterology 48:840–841

    CAS  PubMed  Google Scholar 

  • Kim WR, Mannalithara A, Heimback JK, Kamath PS, Asrani SK, Biggins SW, Wood NL, Gentry SE, Kwong AJ (2021) MELD 3.0: The model of for End-Stage Liver Diseae updated for the modern era. Gastroenterology 161(6):1887–1895. https://doi.org/10.1053/j.gastro.2021.08.050

    Article  PubMed  Google Scholar 

  • Kondo T, Maruyama H, Sekimoto T, Shimada T, Takahashi M, Okugawa H, Yokosuka O, Yamaguchi T (2014) Influence of paraumbilical vein patency on the portal hemodynamics of patients with cirrhosis. J Clin Gastroenterol 48(2):178–183. https://doi.org/10.1097/MCG.0b013e3182a46d84

    Article  PubMed  Google Scholar 

  • Kumamoto M, Toyonaga A, Inoue H, Miyakoda K, Morita Y, Emori K, Sakamoto Y, Oho K, Sata M (2010) Long-term results of balloon-occluded retrograde transvenous obliteration for gastric fundal varices: hepatic deterioration links to portosystemic shunt syndrome. J Gastroenterol Hepatol 25(6):1129–1135. https://doi.org/10.1111/j.1440-1746.2010.06262.x

    Article  PubMed  Google Scholar 

  • Laleman W, Landeghem L, Wilmer A, Fevery J, Nevens F (2005) Portal hypertension: from pathophysiology to clinical practice. Liver Int 25(6):1079–1090. https://doi.org/10.1111/j.1478-3231.2005.01163.x

    Article  CAS  PubMed  Google Scholar 

  • Laleman W, Simon-Talero M, Maleux G, Perez M, Ameloot K, Soriano G, Villalba J, Garcia-Pagan JC, Barrufet M, Jalan R, Brookes J, Thalassinos E, Burroughs AK, Cordoba J, EASL-CLIF-Consortium (2013) Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: a multicenter survey on safety and efficacy. Hepatology 57(6):2448–57. https://doi.org/10.1002/hep.26314

    Article  PubMed  Google Scholar 

  • Lipinski M, Saborowski M, Heidrich B, Attia D, Kasten P, Manns MP, Gebel M, Potthoff A (2018) Clinical characteristics of patients with liver cirrhosis and spontaneous portosystemic shunts detected by ultrasound in a tertiary care and transplantation centre. Scand J Gastroenterol 53(9):1107–1113

    Article  PubMed  Google Scholar 

  • Lv Y, Chen H, Luo B, Bai W, Li K, Wang Z, Xia D, Guo W, Wang Q, Li X, Yuan J, Cai H, Xia J, Yin Z, Fan D, Han G (2022) Transjugular intrahepatic portosystemic shunt with or without gastro-oesophageal variceal embolization for the prevention of variceal rebleeding: a randomized controlled trial. Lancet Gastroenterol Hepatol 7(8):736–746. https://doi.org/10.1016/S2468-1253(22)00087-5

    Article  PubMed  Google Scholar 

  • Lynn AM, Singh S, Congly SE, Khemani D, Johnson DH, Wiesner RH, Kamath PS, Andrews JC, Leise MD (2016) Embolizatino of portosystemic shunts for treatment of medically refractory hepatic encephalopathy. Liver Transpl 22(6):723–731. https://doi.org/10.1002/lt.24440

    Article  PubMed  PubMed Central  Google Scholar 

  • Maruyama H, Kondo T, Kiyono S, Sekimoto T, Takahashi M, Yokosuka O (2015) Influence of splenorenal shunt on long-term outcomes in cirrhosis. Scand J Gastroenterol 50(5):593–600. https://doi.org/10.3109/00365521.2014.1003401

    Article  PubMed  Google Scholar 

  • Mostbeck GH, Wittich GR, Herold C, Vergesslich KA, Walter RM, Frotz S, Sommer Gl (1989) Hemodynamic significance of the para-umbilical vein in portal hypertension: assessment with duplex US. Radiology 170:339–342. https://doi.org/10.1148/radiology.170.2.2643137

    Article  CAS  PubMed  Google Scholar 

  • Moubarak E, Bouvier A, Boursier J, Lebigot J, Ridereau-Zins C, Thouveny F, Willoteaux S, Cl A (2012) Portosystemic collateral vessels in liver cirrhosis: a three-dimensional MDCT pictorial review. Abdom Imaging 37:746–766. https://doi.org/10.1007/s00261-011-9811-0

    Article  PubMed  Google Scholar 

  • Naeshiro N, Kakizawa H, Aikata H, Kan H, Fujino H, Fukuhara T, Kobayashi T, Honda Y, Miyaki D, Kawaoka T, Tsuge M, Hiramatsu A, Imamura M, Kawakami Y, Hyogo H, Ishikawa M, Awai K, Chayama K (2014) Percutaneous transvenous embolization for portosystemic shunts associated with encephalopathy: longterm outcomes in 14 patients. Hepatol Res 44(7):740–749. https://doi.org/10.1111/hepr.12181

    Article  PubMed  Google Scholar 

  • Nardelli S, Riggio O, Turco L, Gioia S, Puzzono M, Bianchini M, Ridola L, Aprile F, Gitto S, Pelle G, Di Martino M, Marzocchi G, Caporali C, Spagnoli A, Di Rocco A, Schepis F (2021) Relevance of spontaneous portoystemic shunts dected with CT in patients with cirrhosis. Radiology 299(1):133–140. https://doi.org/10.1148/radiol.2021203051

    Article  PubMed  Google Scholar 

  • Onishi K, Sato S, Saito M, Terabayashi H, Nakayam T, Saito M, Chin N, Iida S, Nomura F, Okuda K (1986) Clinical and portal haemodynamic features in cirrhotic patients having a large spontaneous splenorenal and/or gastrorenal shunt. Am J Gastroenterol 81(6):450–455

    Google Scholar 

  • Patel M, Molvar C (2018) Evolution of retrograde transvenous obliteration techniques. Semin Intervent Radiol 35(3):185–193. https://doi.org/10.1055/s-0038-1660796

    Article  PubMed  PubMed Central  Google Scholar 

  • Philips CA, Arora A, Shetty R, Kasana, (2016) A comprehensive review of portosystemic collaterals in cirrhosis: historical aspects, anatomy, and classifications. Int J Hepatol 2016:6170243. https://doi.org/10.1155/2016/6170243

    Article  PubMed  PubMed Central  Google Scholar 

  • Philips CA, Kumar L, Augustine P (2017) Shunt occlusion for portosystemic shunt syndrome related refractory hepatic encephalopathy – a single center experience in 21 patients from Kerala. Indian J Gastroenterol 36(5):411–419. https://doi.org/10.1007/s12664-017-0787-8

    Article  PubMed  Google Scholar 

  • Praktiknjo M, Simón-Talero M, Römer J, Roccarina D, Martínez J, Lampichler K, Baiges A, Low G, Llop E, Maurer MH, Zipprich A, Triolo M, Maleux G, Fialla AD, Dam C, Vidal-González J, Majumdar A, Picón C, Toth D, Darnell A, Abraldes JG, López M, Jansen C, Chang J, Schierwagen R, Uschner F, Kukuk G, Meyer C, Thomas D, Wolter K, Strassburg CP, Laleman W, La Mura V, Ripoll C, Berzigotti A, Calleja JL, Tandon P, Hernandez-Gea V, Reiberger T, Albillos A, Tsochatzis EA, Krag A, Genescà J, Trebicka J, Baveno VI-SPSS group of the Baveno Cooperation (2020) Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis. J Hepatol 72(6):1140–1150. https://doi.org/10.1016/j.jhep.2019.12.021

    Article  PubMed  Google Scholar 

  • Rathi S, Brocco S, Formentin C, Zarantonello L, Mangini C, Meneghello G, Merkel C, Angeli P, Stramare R, Montagnese S, Amodio P (2021) Spontaneous portosystemic shunts in cirrhosis: detection, implications and clinical associations. Dig Liver Dis 53(11):1468–1475. https://doi.org/10.1016/j.dld.2020.11.020

    Article  PubMed  Google Scholar 

  • Riggio O, Efrati C, Catalano C, Pediconi F, Mecarelli O, Accornero N, Nicolao F, Angeloni S, Masini A, Ridola L, Attili AF, Merli M (2005) High prevalence of spontaneous portal-systemic shunts in persistent hepatic encephalopathy: a case-control study. Hepatology 42(5):1158–1165. https://doi.org/10.1002/hep.20905

    Article  PubMed  Google Scholar 

  • Rodriguez EA, Perez R, Zhang N, Lim ES, Miller C, Schwartz MA, McGIrr AJ, Srinivasan A, Hewitt W, Silva AC, Rakela J, Vargas HE (2020) Clinical outcomes of portosystemic shunts on the outcome of liver transplantation. Liver Transpl 26:693–701. https://doi.org/10.1002/lt.25710

    Article  PubMed  Google Scholar 

  • Roggeri A, Roggeri DP, Rossi E, Cinconze E, Gasbarrini A, Preti PM, De Rosa M (2015) Overt hepatic encephalopathy in Italy: clinical outcomes and healthcare costs. Hepatic Med Evid Res 7:37–42

    Article  Google Scholar 

  • Saad WE, Lippert A, Saad NE, Caldwell S (2013) Ectopic varices: anatomical classification, hemodynamic classification, and hemodynamic-based management. Tech Vasc Interv Radiol 16(2):158–175. https://doi.org/10.1053/j.tvir.2013.02.004

    Article  PubMed  Google Scholar 

  • Sacerdoti D, Bolognesi M, Bombonato G, Gatta A (1995) Paraumbilical vein patency in cirrhosis: effects on hepatic hemodynamics evaluated by doppler sonography. Hepatology 22(6):1689–1694

    CAS  PubMed  Google Scholar 

  • Sakurabayashi S, Sezai S, Yamamoto Y, Hirano M (1997) Oka H (1997) Embolization of portal-systemic shunts in cirrhotic patients with chronic recurrent hepatic encephalopathy. Cardiovasc Intervent Radiol 20:120–124. https://doi.org/10.1007/s002709900118

    Article  CAS  PubMed  Google Scholar 

  • Shaheen AA, Nguyen HH, Congly SE, Kaplan GG, Swain MG (2019) Nationwide estimates and risk factors of hospital readmission in patients with cirrhosis in the United States. Liver Int 39:78–884

    Article  Google Scholar 

  • Simón-Talero M, Roccarina D, Martínez J, Lampichler K, Baiges A, Low G, Llop E, Praktiknjo M, Maurer MH, Zipprich A, Triolo M, Vangrinsven G, Garcia-Martinez R, Dam A, Majumdar A, Picón C, Toth D, Darnell A, Abraldes JG, Lopez M, Kukuk G, Krag A, Bañares R, Laleman W, La Mura V, Ripoll C, Berzigotti A, Trebicka J, Calleja JL, Tandon P, Hernandez-Gea V, Reiberger T, Albillos A, Tsochatzis EA, Augustin S, Genescà J, Baveno VI-SPSS group from the Baveno Cooperation (2018) Association between portosystemic shunts and increased complications and mortality in patients with cirrhosis. Gastroenterology 154(6):1694–1705. https://doi.org/10.1053/j.gastro.2018.01.028

    Article  PubMed  Google Scholar 

  • Tapper EB, Zhao L, Nikirk S, Baki J, Parikh ND, Lok AS, Waljee AK (2020) Incidence and bedside predictors of the first episode of overt hepatic encephalopathy in patients with cirrhosis. Am J Gastroenterol 115(12):2017–2025. https://doi.org/10.14309/ajg.0000000000000762

    Article  PubMed  PubMed Central  Google Scholar 

  • Tarantino G, Citro V, Conca P, Riccio A, Tarantino M, Capone D, Cirillo M, Lobello R, Iaccarino V (2009) What are the implications of the spontaneous spleno-renal shunts in liver cirrhosis? BMC Gastroenterol 9:89. https://doi.org/10.1186/1471-230X-9-89

    Article  PubMed  PubMed Central  Google Scholar 

  • Uflacker R, Silva Ade O, d’Albuquerque LA, Piske RL, Mourao GS (1987) Chronic portosystemic encephalopathy: embolisation of portosystemic shunts. Radiology 165:721–725

    Article  CAS  PubMed  Google Scholar 

  • Vidal-Gonzalez J, Quiroga S, Simon-Talero M, Genesca J (2020) Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem. Ther Adv Gastroenterol 13:1–19

    Article  Google Scholar 

  • Von Herbay A, Frieling T, Häussinger D (2000) Color Doppler sonographic evaluation of spontaneous portosystemic shunts and inversion of portal venous flow in patients with cirrhosis. J Clin Ultrasound JCU 28:332–339

    Article  Google Scholar 

  • Wolter K, Praktiknjo M, Boie J, Decker G, Nadal J, Jansen C, Keller WIY, Meyer C, Trebicka J, Attenberger U, Thomas D (2021) Glue embolization of gastrooesophageal varices during transjugular intrahepatic portosystemic shunt (TIPS) improves survival compared to coil-only embolization- A single-center retrospective study. Cardiovasc Intervent Radiol 44(8):1240–1250. https://doi.org/10.1007/s00270-021-02852-y

    Article  PubMed  PubMed Central  Google Scholar 

  • Zardi EM, Uwechie V, Caccavo D, Pellegrino NM, Cacciapaglia F, Di Matteo F, Dobrina A, Laghi V, Afeltra A (2009) Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance. J Gastroenterol 44(1):76–83. https://doi.org/10.1007/s00535-008-2279-1

    Article  PubMed  Google Scholar 

  • Zidi SH, Zanditenas D, Gelu-Simeon M, Rangheard AS, Valla DC, Vilgrain V, Pelletier GM (2007) Treatment of chronic portosystemic encephalopathy in cirrhotic patients by embolization of portosystemic shunts. Liver Int 27:1389–1393

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This review article is based on a talk given at the International Society for Hepatic Encephalopathy & Nitrogenous metabolism in 10-2021 and is written under the aegis of the European HORIZON 2020 project MICROB-PREDICT (grant No 825694)

Funding

MP is funded by the Ernst-und-Berta Grimmke Foundation (No. 5/19) and BONFOR research program of the University of Bonn (grant ID 2020-2A-07 and 2021-2A-07) and by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany’s Excellence Strategy – EXC2151 – 390873048.

JT was supported by the German Research Foundation (DFG) project ID 403224013 – SFB 1382 (A09), by the German Federal Ministry of Education and Research (BMBF) for the DEEP-HCC project and by the Hessian Ministry of Higher Education, Research and the Arts (HMWK) for the ENABLE and ACLF-I cluster projects. The MICROB-PREDICT (project ID 825694), DECISION (project ID 847949), GALAXY (project ID 668031), LIVERHOPE (project ID 731875), and IHMCSA (project ID 964590) projects have received funding from the European Union’s Horizon 2020 research and innovation program. The manuscript reflects only the authors’ views, and the European Commission is not responsible for any use that may be made of the information it contains. WL received funding from the MICROB-PREDICT (project ID 825694).

The funders had no influence on study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Section of Liver and Biliopancreatic Disorders, University Hospitals Leuven, KU Leuven, Leuven, Belgium

    Wim Laleman, Emma Vanderschueren & Chris Verslype

  2. Medizinische Klinik B, Universitätsklinikum Münster, Münster University, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany

    Wim Laleman, Michael Praktiknjo & Jonel Trebicka

  3. Department of Gastroenterology and Hepatology, University Hospital of South Denmark, Esbjerg, Denmark

    Mette Munk Lauridsen & Aleksander Krag

  4. Department of Radiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium

    Lawrence Bonne & Geert Maleux

  5. European Foundation of Chronic Liver Failure, EFCLIF, Barcelona, Spain

    Jonel Trebicka

Authors
  1. Wim Laleman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Praktiknjo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mette Munk Lauridsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lawrence Bonne
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emma Vanderschueren
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chris Verslype
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Aleksander Krag
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jonel Trebicka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Geert Maleux
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The first draft of the manuscript was written by Wim Laleman and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Wim Laleman.

Ethics declarations

Ethics approval

Not applicable.

Competing interests

The authors have no relevant financial or non-financial interests to disclose in regard of this paper.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Laleman, W., Praktiknjo, M., Lauridsen, M.M. et al. Closing spontaneous portosystemic shunts in cirrhosis: Does it make sense? Does it work? What does it take?. Metab Brain Dis 38, 1717–1728 (2023). https://doi.org/10.1007/s11011-022-01121-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11011-022-01121-2

Keywords

Search

Navigation