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.
|
Authors | Osamu Ikeda, Seijiro Inoue, Yoshitaka Tamura, Yo-Ichi Yamashita, Hideo Baba, Yukihiro Inomata, Yasuyuki Yamashita |
Journal | Acta radiologica (Stockholm, Sweden : 1987)
(Acta Radiol)
Vol. 59
Issue 4
Pg. 441-447
(Apr 2018)
ISSN: 1600-0455 [Electronic] England |
PMID | 28791885
(Publication Type: Journal Article)
|
Topics |
- Adult
- Aged
- Embolization, Therapeutic
(methods)
- Female
- Hepatic Encephalopathy
(physiopathology, therapy)
- Humans
- Liver Circulation
(physiology)
- Male
- Middle Aged
- Portal Vein
(physiopathology)
- Retrospective Studies
- Splenic Vein
(physiopathology)
- Stents
- Treatment Outcome
- Venous Thrombosis
(physiopathology, therapy)
|