Successful control of portal hypertension-related complications after two embolization procedures for multiple and large spontaneous portosystemic shunts in a patient with liver cirrhosis.

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Tytuł:: Successful control of portal hypertension-related complications after two embolization procedures for multiple and large spontaneous portosystemic shunts in a patient with liver cirrhosis.
Autorzy:: Ueno W; Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan.
Sato N; Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan.
Miura K; Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan. .
Morimoto N; Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan.
Watanabe S; Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan.
Nomoto H; Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan.
Isoda N; Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan.
Kijima S; Department of Radiology, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan.
Kikuchi T; Department of Radiology, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan.
Manaka S; Department of Radiology, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan.
Mori H; Department of Radiology, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan.
Yamamoto H; Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, 329-0498, Japan.
Źródło:: Clinical journal of gastroenterology [Clin J Gastroenterol] 2021 Aug; Vol. 14 (4), pp. 1227-1232. Date of Electronic Publication: 2021 May 16.
Typ publikacji:: Case Reports; Journal Article
Język:: English
Imprint Name(s):: Original Publication: [Tokyo] : Springer Japan
MeSH Terms:: Balloon Occlusion*
Carcinoma, Hepatocellular*
Chemoembolization, Therapeutic*
Esophageal and Gastric Varices*/etiology
Esophageal and Gastric Varices*/therapy
Hepatic Encephalopathy*/etiology
Hepatic Encephalopathy*/therapy
Hypertension, Portal*/complications
Liver Neoplasms*
Portasystemic Shunt, Transjugular Intrahepatic*
Child, Preschool ; Humans ; Liver Cirrhosis/complications ; Male ; Treatment Outcome
References:: Simón-Talero M, Roccarina D, Martínez J, et al. Association between portosystemic shunts and increased complications and mortality in patients with cirrhosis. Gastroenterology. 2018;154:1694–705 (e4). (PMID: 10.1053/j.gastro.2018.01.028)
Nardelli S, Riggio O, Turco L, et al. Relevance of spontaneous portosystemic shunts detected with CT in patients with cirrhosis. Radiology. 2021;2021:203051.
Lee EW, Lee AE, Saab S, et al. Retrograde transvenous obliteration (RTO): A New Treatment Option For Hepatic Encephalopathy. Dig Dis Sci. 2020;65:2483–91. (PMID: 10.1007/s10620-020-06050-7)
Praktiknjo M, Simón-Talero M, Römer J, et al. Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis. J Hepatol. 2020;72:1140–50. (PMID: 10.1016/j.jhep.2019.12.021)
Vidal-González J, Quiroga S, Simón-Talero M, et al. Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem. Therap Adv Gastroenterol. 2020;13:1756284820961287. (PMID: 10.1177/1756284820961287)
Ishikawa T, Hamamoto K, Sasaki R, et al. Significant improvement in portal-systemic liver failure symptoms and successful management of portal-splenic venous hemodynamics by the combination of interventional radiology and pharmacotherapy. Hepatol Res. 2020;50:1201–8. (PMID: 10.1111/hepr.13545)
Miyamoto Y, Oho K, Kumamoto M, et al. Balloon-occluded retrograde transvenous obliteration improves. J Gastroenterol Hepatol. 2003;18:934–42. (PMID: 10.1046/j.1440-1746.2003.03087.x)
Ishikawa T, Sasaki R, Nishimura T, et al. Comparison of patients with hepatic encephalopathy and those with gastric varices before and after balloon-occluded retrograde transvenous obliteration. Hepatol Res. 2018;48:1020–30. (PMID: 10.1111/hepr.13199)
Scheiner B, Ulbrich G, Mandorfer M, et al. Short- and long-term effects of transarterial chemoembolization on portal hypertension in patients with hepatocellular carcinoma. United European Gastroenterol J. 2019;7:850–8. (PMID: 10.1177/2050640619840199)
Inoue M, Tanaka T, Nakagawa H, et al. Splenic Vein Embolization Using Coil Anchors and Prophylactic Occlusion of a Hepatofugal Collateral for Hepatic Encephalopathy due to Splenorenal Shunt: Technical Note and Literature Review. Case Rep Radiol. 2013;2013:160653.
Contributed Indexing:: Keywords: Balloon-occluded retrograde transvenous obliteration; Coil embolization; Liver cirrhosis; Portal hypertension; Spontaneous portosystemic shunts
Entry Date(s):: Date Created: 20210516 Date Completed: 20210726 Latest Revision: 20210726
Update Code:: 20240105
DOI:: 10.1007/s12328-021-01441-3
PMID:: 33993428
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Liver cirrhosis is frequently complicated by spontaneous portosystemic shunt (SPSS) due to portal hypertension. Shunt embolization is considered when symptoms related to SPSSs are refractory to endoscopic and/or medical therapies. However, little information is available on the treatment of patients with multiple and large SPSS. We report a successfully managed case in which patient with such SPSS received two embolization procedures within 6 months. A 57-year-old man with alcoholic liver cirrhosis was transferred to our hospital due to a ruptured gastric varix. CT examination showed gastrorenal and splenorenal shunts of 8 mm and 11 mm in diameter, respectively. In addition, multiple hepatocellular carcinomas (HCCs) were noted. First, balloon-occluded retrograde transvenous obliteration (BRTO) was performed for the gastrorenal shunt, resulting in the disappearance of the varix, followed by transcatheter arterial chemoembolization (TACE) for HCCs. However, the hepatic encephalopathy worsened after the BRTO and TACE, and the splenorenal shunt enlarged to 18 mm in diameter. Although the shunt was tortuous and had another drainage vein, we completed the embolization for the shunt using metallic coils without any events. The patient's hepatic encephalopathy and hepatic function were ameliorated after embolization for the splenorenal shunt, and the patient was free from hepatic encephalopathy.
(© 2021. Japanese Society of Gastroenterology.)

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