Hepatic Encephalopathy Due to Intrahepatic Portosystemic Venous Shunt Successfully Treated by Interventional Radiology

Hiraoka, Atsushi; Kurose, Kiyotaka; Hamada, Maho; Azemoto, Nobuaki; Terada, Yoshio; Hirooka, Masashi; Hasebe, Aki; Kumagi, Teru; Hirata, Masaaki; Michitaka, Kojiro; Minami, Hisaka; Murakami, Masato; Isobe, Yoshinori; Horiike, Norio; Onji, Morikazu

doi:10.2169/internalmedicine.44.212

Cited by 15 publications

(13 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, the ICG test was performed only in 46.2% of the present patients with HCC in all institutions. In addition, there are issues related to bolus injection of ICG, needed for an ICG test, and allergy to ICG, and constitutional ICG excretory defect [28] and the possibility of underestimation of hepatic function for patients who have a progressed portal-venous shunt [29] have been reported. Moreover, there might also be problems when liver damage and Child-Pugh, which has been reported to be inferior to liver damage [8] , are used together in the evidence-based JSH guideline.…”

Section: Discussionmentioning

confidence: 99%

Albumin-Bilirubin (ALBI) Grade as Part of the Evidence-Based Clinical Practice Guideline for HCC of the Japan Society of Hepatology: A Comparison with the Liver Damage and Child-Pugh Classifications

et al. 2017

Self Cite

View full text Add to dashboard Cite

Aim/Background: The purpose of this study was to evaluate the validity of 3 classifications for assessing liver function, the liver damage and Child-Pugh classifications and the newly proposed albumin-bilirubin (ALBI) grade, in order to examine the feasibility of evaluating hepatic function using ALBI grade with the hepatocellular carcinoma (HCC) treatment algorithm used in Japan. Methods: We analyzed the medical records of 3,495 Japanese HCC patients admitted from 2000 to 2015, which were comprised of 1,580 patients hospitalized in the Ehime Prefecture area and used as a training cohort (Ehime group), and 1,915 others who were used for validation (validation group). ALBI score used for grading ( ≤ -2.60 = grade 1, greater than -2.60 to ≤ -1.39 = grade 2, greater than -1.39 = grade 3) as well as clinical features and prognosis (Japan Integrated Staging [JIS], modified JIS, ALBI-TNM [ALBI-T] score) were retrospectively investigated. Results: For prediction of liver damage A, the values for sensitivity and specificity, positive predictive and negative predictive values, and positive and negative likelihood ratios of ALBI-1 and Child-Pugh A were similar among the 2 groups. Akaike information criterion results showed that prognosis based on ALBI grade/ALBI-T score was better than that based on liver damage/modified JIS score and Child-Pugh/JIS score (22,291.8/21,989.4, 22,379.6/22,076.0, 22,392.1/22,075.1, respectively). The cutoff values for ALBI score for indocyanine green retention rate at 15 min (ICG-R15) <10, <20, and <30% were -2.623 (area under the curve [AUC]: 0.798), -2.470 (AUC: 0.791), and -2.222 (AUC: 0.843), respectively. The distribution of ICG-R15 (<10%, 10 to <20%, 20 to <30%, and ≥ 30%) for ALBI grade 1 was similar to that for liver damage A. There were only small differences with regard to therapeutic selection with the Japanese HCC treatment algorithm between liver damage and ALBI grade. Conclusion: ALBI grade is a useful and easy classification system for assessment of hepatic function for therapeutic decision making.

show abstract

Section: Discussionmentioning

confidence: 99%

Albumin-Bilirubin (ALBI) Grade as Part of the Evidence-Based Clinical Practice Guideline for HCC of the Japan Society of Hepatology: A Comparison with the Liver Damage and Child-Pugh Classifications

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…Since being first reported by Ohtomo et al [2], transcatheter embolization has been accepted as a noninvasive and effective treatment for symptomatic IPSVS [1, 2, 3, 4, 5, 6, 7, 8, 9]. The technical approaches of transcatheter embolization for IPSVS include transileocolic, percutaneous transhepatic, and retrograde transcaval embolization.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the invasiveness of surgical interventions, such as shunt ligation, hepatic resection, or liver transplantation, transcatheter embolization of the causative vessel has been widely used for the last 3 decades [1, 2, 3, 4, 5, 6, 7, 8, 9]. …”

Section: Introductionmentioning

confidence: 99%

Hepatic Encephalopathy due to Congenital Multiple Intrahepatic Portosystemic Venous Shunts Successfully Treated by Percutaneous Transhepatic Obliteration

Takenaga

Narita

Matsui

et al. 2016

Case Rep Gastroenterol

View full text Add to dashboard Cite

Hepatic encephalopathy due to intrahepatic portosystemic venous shunts (IPSVS) in a non-cirrhotic condition is rare. Here we report a rare case of a patient with congenital multiple IPSVS successfully treated by percutaneous transhepatic obliteration. The patient was a 67-year-old woman who presented to our hospital with progressive episodes of consciousness disorder and vomiting. Laboratory tests revealed hyperammonemia (192.0 μg/dL), and computed tomography revealed multiple IPSVS in both lobes. There was no evidence of underlying liver disease or hepatic trauma. Transcatheter embolization for IPSVS was performed because conservative therapy was not sufficiently effective. After endovascular shunt closure, hepatic encephalopathy improved. The serum ammonia level normalized during the 5-year follow-up period. Thus, transcatheter embolization may be an effective therapy for patients with symptomatic and refractory IPSVS. Careful follow-up is necessary for portal hypertension-related complications after transcatheter embolization for IPSVS.

show abstract

“…There have been two previous reports of patients with a portal aneurysm which was successfully obliterated with microcoils via the retrograde transvenous route [7, 8]. However, numerous microcoils were required to obliterate even a small portal aneurysm, and not only microcoils but also sclerosing agents were required to achieve complete obliteration [7].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical ligation, hepatectomy, and non-surgical treatment with interventional radiology (IVR) have been reported to be effective for intrahepatic portosystemic venous shunt (IPVS) with repeated hepatic encephalopathy [1,2,3,4,5,6,7,8]. Numerous variations between the portal vein and the hepatic vein in IPVS have been reported [9], but there are no standard therapeutic methods.…”

Section: Introductionmentioning

confidence: 99%

Surgical Shunt Closure via the Lumen of an Intrahepatic Portal Aneurysm

Ariizumi

Takasaki²,

Yamamoto³

et al. 2006

Dig Surg

View full text Add to dashboard Cite

Background/Aims: A surgical shunt closure via the lumen of an intrahepatic portal aneurysm was successfully performed in a 70-year-old Japanese woman with hepatic encephalopathy due to hyperammonemia. She had a 4-month history of repeated hepatic encephalopathy which persisted after treatment with oral medicine. Color Doppler ultrasonography and computed tomography revealed a cystic peripheral portal aneurysm, 4 cm in diameter, connecting the posterior branch of the portal vein to the short hepatic vein in the right lobe. Methods: While performing the Pringle maneuver and clamping the inferior vena cava below the liver, the wall of the portal aneurysm was opened, and the site of inflow from the portal vein and the site of outflow to the hepatic vein via the lumen of the portal aneurysm were closed with interrupted sutures. Results: The patient’s postoperative course was uneventful, and she was discharged 12 days after surgery. 12 months after surgery, she had no recurrence of hyperammonemia or hepatic encephalopathy. Conclusion: Surgical shunt closure via the lumen of a portal aneurysm can be performed safely, easily, and completely with good vision.

show abstract

Hepatic Encephalopathy Due to Intrahepatic Portosystemic Venous Shunt Successfully Treated by Interventional Radiology

Cited by 15 publications

References 11 publications

Albumin-Bilirubin (ALBI) Grade as Part of the Evidence-Based Clinical Practice Guideline for HCC of the Japan Society of Hepatology: A Comparison with the Liver Damage and Child-Pugh Classifications

Albumin-Bilirubin (ALBI) Grade as Part of the Evidence-Based Clinical Practice Guideline for HCC of the Japan Society of Hepatology: A Comparison with the Liver Damage and Child-Pugh Classifications

Hepatic Encephalopathy due to Congenital Multiple Intrahepatic Portosystemic Venous Shunts Successfully Treated by Percutaneous Transhepatic Obliteration

Surgical Shunt Closure via the Lumen of an Intrahepatic Portal Aneurysm

Contact Info

Product

Resources

About