Post-TIPS hepatic encephalopathy treated by occlusion balloon-assisted retrograde embolization of a coexisting spontaneous splenorenal shunt.
A 51-year-old man with posthepatitis cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for bleeding of recurrent esophageal varices. The patient had a coexisting, spontaneous, splenorenal shunt. He subsequently developed hepatic encephalopathy, presumably due to excessive portosystemic shunting. Since medical management resulted in no significant improvement, the splenorenal shunt was embolized from the jugular vein approach via renal vein access during temporary balloon occlusion. Within a few days, the patient's hepatic encephalopathy resolved. Twelve months later the patient showed no recurrence of encephalopathy and had maintained a patent TIPS.
Shioyama
Y
Y
Department of Radiology, Central Hospital and Cancer Center of Ibaraki Prefecturer, Japan.
Matsueda
K
K
Horihata
K
K
Kimura
M
M
Nishida
N
N
Kishi
K
K
Terada
M
M
Sato
M
M
Yamada
R
R
D002404:Catheterization / Q000295:instrumentation*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000628:therapy*; D005402:Fistula / Q000628:therapy*; D006501:Hepatic Encephalopathy / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011170:Portasystemic Shunt, Surgical / Q000295:instrumentation*; D012008:Recurrence; D012082:Renal Veins / Q000000981:diagnostic imaging; D013162:Splenic Vein / Q000000981:diagnostic imaging; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging