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- Title
Shunt-preserving disconnection of the portal to systemic circulation in patients with hepatic encephalopathy.
- Authors
Ikeda, Osamu; Inoue, Seijiro; Tamura, Yoshitaka; Yamashita, Yo-ichi; Baba, Hideo; Inomata, Yukihiro; Yamashita, Yasuyuki
- Abstract
Background Portosystemic shunt obliteration by surgical or interventional radiological techniques can be effective for patients with hepatic encephalopathy (HE) although this approach is often associated with accumulation of ascites and/or formation of esophageal varices. Purpose To evaluate the clinical efficacy and safety of shunt-preserving disconnection of the portosystemic circulation (SPDPS) in patients with HE. Material and Methods Nine patients with HE and a splenorenal shunt were treated by SPDPS: eight underwent selective coil embolization of the splenic vein and one underwent stent-graft closure of the shunt. The primary endpoint was change in HE severity based on the West-Haven criteria. The secondary endpoints were changes in serum ammonia levels, hepatic function, HE recurrence during the follow-up period, and post-treatment HE recurrence based on the West-Haven diagnostic criteria. Results The technical success rate was 100% with no severe complications. After the procedure, the mean portal blood pressure increased from 18 mmHg to 22 mmHg ( P = 0.02), the mean HE grades fell from 2.1 to 1.1 ( P < 0.01), and one month after the procedure, the mean serum ammonia level decreased from 177 µg/dL to 87 µg/dL ( P = 0.03) and the mean total Child-Pugh score from 8 to 7 ( P = 0.07). Conclusion SPDPS using selective coil embolization and stent-graft closure of the shunt can be an effective and safe treatment for patients with HE.
- Subjects
HEPATIC encephalopathy; SURGICAL anastomosis; INTERVENTIONAL radiology; ESOPHAGEAL varices; SPLENIC vein; VENOUS thrombosis treatment; LIVER blood-vessels; PORTAL vein; SURGICAL stents; VENOUS thrombosis; THERAPEUTIC embolization; TREATMENT effectiveness; RETROSPECTIVE studies; PHYSIOLOGY; THERAPEUTICS
- Publication
Acta Radiologica, 2018, Vol 59, Issue 4, p441
- ISSN
0284-1851
- Publication type
journal article
- DOI
10.1177/0284185117722810