Symptomatic Intrahepatic Portosystemic Venous Shunt: Embolization with an Alternative Approach

Abstract

On angiography, two types of intrahepatic portosystemic venous shunt were seen: intrahepatic portal venous-hepatic venous communication and intrahepatic portal venous-perihepatic venous communication. Transcatheter embolization is effective for treatment of intrahepatic portosystemic venous shunt. Retrograde transcaval obliteration is the least invasive technique and is recommended as the first choice for treatment of portosystemic venous shunt except in patients with multiple shunts.

Asymptomatic Aneurysmal Portosystemic Venous Shunt: A Case Report and Review of the Literature

“…Another case was reported of a newborn with a shunt with spontaneous resolve in first year of age (8,13). SIPSVS may be demonstrated in any age of life between 20-day-old and late seventies (3,5,12,14,18,19,20,22,24,26,31). Wide range distribution in case reports may make us speculate role of different mechanism in development of SIPSVS.…”

“…Retrograde transcaval obliterationis the least invasive technique and is recommended as the first choice for treatment of portosystemic venous shunt except in patients with multiple shunts. Surgical intervention such as shunt ligation anf hepatic resection, creation of an alternative portsystemic shunt are additional therapeutic approach descibed in literature (6,17,21,26,31).…”

Efficacy and Safety of Transcatheter Embolization for Hepatic Encephalopathy Caused by Spontaneous Portosystemic Shunts

“…The traditional approach to treating a shunt vessel is surgical removal or ligation [6]. However, transcatheter embolization of the causative vessel has been widely accepted and rapidly used worldwide because of its less invasive nature [7]. In addition, the development of endovascular devices, such as microcatheters, balloon occlusion catheters, metallic coils, and vascular plugs, have enabled safe and certain embolization.…”

“…An antegrade technique is performed through two access routes: percutaneous transhepatic obliteration (PTO) and trans-ileocolic vein obliteration (TIO) [7,14]. The advantages of using an antegrade technique are that the portal pressure can be monitored directly, and the global image of portal venous systems, including the details of collateral vessels, can be clearly demonstrated by injection of contrast medium.…”

“…Therefore, TIO might be performed on patients with special hemodynamic situations, such as multiple intrahepatic portosystemic shunts [7].…”