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


CONCLUSIONS
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.
Sakurabayashi
S
S
Division of Gastroenterology, Tokyo Metropolitan Police Hospital, 2-10-41 Fujimi, Chiyoda-ku, Tokyo 102, Japan.
Sezai
S
S
Yamamoto
Y
Y
Hirano
M
M
Oka
H
H
D000368:Aged; D000641:Ammonia / Q000097:blood; D001783:Blood Flow Velocity; D002908:Chronic Disease; D004569:Electroencephalography; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006503:Hepatic Veins; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D011169:Portal Vein; D012008:Recurrence; D012082:Renal Veins; D013162:Splenic Vein; D013270:Stomach / Q000098:blood supply
D000641:Ammonia