title: Management of surgical splenorenal shunt-related hepatic myelopathy with endovascular interventional techniques.
abstract: We present a case with hepatic myelopathy (HM) due to a surgical splenorenal shunt that was successfully treated by endovascular interventional techniques. A 39-year-old man presented with progressive spastic paraparesis of his lower limbs 14 mo after a splenorenal shunt. A portal venogram identified a widened patent splenorenal shunt. We used an occlusion balloon catheter initially to occlude the shunt. Further monitoring of the patient revealed a decrease in his serum ammonia level and an improvement in leg strength. We then used an Amplatzer vascular plug (AVP) to enable closure of the shunt. During the follow up period of 7 mo, the patient experienced significant clinical improvement and normalization of blood ammonia, without any complications. Occlusion of a surgically created splenorenal shunt with AVP represents an alternative therapy to surgery or coil embolization that can help to relieve shunt-induced HM symptoms.
authors: Department of Interventional Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China. wangmq@vip.sina.com
authors: Mao-Qiang
authors: MQ
authors: Wang
authors: Feng-Yong
authors: FY
authors: Liu
authors: Feng
authors: F
authors: Duan
mesh_terms: D000328:Adult; D021721:Balloon Occlusion / Q000379:methods; D002404:Catheterization; D057510:Endovascular Procedures; D006501:Hepatic Encephalopathy / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007668:Kidney / Q000601:surgery*; D008297:Male; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000601:surgery; D013154:Spleen / Q000601:surgery*; D013164:Splenorenal Shunt, Surgical / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: Amplatzer vascular plug; Embolization; Endovascular balloon occlusion; Hepatic encephalopathy; Hepatic myelopathy; Interventional procedures; Portosystemic; Shunts