Percutaneous transvenous embolization for portosystemic shunts associated with encephalopathy: Long‐term outcomes in 14 patients

Naeshiro, Noriaki; Kakizawa, Hideaki; Aikata, Hiroshi; Kan, Hiromi; Fujino, Hatsue; Fukuhara, Toru; Kobayashi, Tomoki; Honda, Yohji; Miyaki, Daisuke; Tsuge, Masataka; Hiramatsu, Akira; Kawakami, Yoshiiku; Hyogo, Hideyuki; Ishikawa, M.; Awai, Kazuo; Chayama, Kazuaki

doi:10.1111/hepr.12181

Cited by 31 publications

(28 citation statements)

References 29 publications

(58 reference statements)

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“…Several authors have reported the safety and efficacy of transcatheter embolization of portosystemic shunts in patients with refractory HE [13,[32][33][34][35][36][37][38]. In addition, in the previous 10 years, many case reports on HE due to portosystemic shunts that were successfully treated by transcatheter embolization have been published [17][18][19][20][21][22][23][39][40][41][42].…”

Section: Efficacy and Safety Of Transcatheter Embolizationmentioning

confidence: 99%

“…The details and outcomes of the reviewed studies are listed in Table 1 [13,[32][33][34][35][36][37][38].…”

Section: Efficacy and Safety Of Transcatheter Embolizationmentioning

confidence: 99%

“…Regarding the clinical success of portosystemic shunt embolization for HE, the reported short-to-intermediate-term improvement rates of the condition range from 85.7% to 100% [13,32,33,36]. Laleman et al [35] performed a multicenter study involving 37 patients and found that 59.4% of patients were free of HE within 100 days after embolization of portosystemic shunts, and 48.6% of those patients remained symptom free over the long-term (mean follow-up period of 697 157 days).…”

Section: Efficacymentioning

confidence: 99%

“…The recurrence rates of HE in clinical studies with a relatively large number of cases and comparatively longer follow-up periods range from 7.1% to 39.9% [32][33][34][35]. An et al [34] reported that the 2-year HE recurrence rate was significantly lower in patients treated with embolization than in those treated without embolization (33.9% vs. 79.9%, respectively), and the 2-year overall survival rate in patients with a MELD score < 15 without hepatocellular carcinoma was significantly higher in the embolization group than in the non-embolization group (100% vs. 60%, respectively).…”

Section: Efficacymentioning

confidence: 99%

“…In clinical studies with a relatively high number of cases and comparatively longer follow-up periods, the incidence of esophageal varices after portosystemic shunt embolization ranges from 5% to 28.9% [32][33][34][35]. A multicenter study by Laleman et al [35] showed that 2 of 37 patients (5%) developed esophageal varices after embolization of a portosystemic shunt, of which one patient (2.5%) experienced nonfatal variceal bleeding.…”

Section: Table 1 Summary Of Published Reports Of Transcatheter Embolmentioning

confidence: 99%

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

Takenaga

Aizawa

2017

Interventional Radiology

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Hepatic encephalopathy (HE) is a syndrome that occurs in patients with severe liver dysfunction or a portosystemic shunt. In patients with refractory HE caused by a portosystemic shunt, interventional closure of the shunt vessel is essential. Currently, transcatheter embolization is recognized as a less invasive and highly effective procedure, and it is considered as a first-choice method for the occlusion of shunt vessels. In this review, we discuss the role of a portosystemic shunt in the development of HE and describe the procedure and significance of transcatheter embolization of a portosystemic shunt.

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Section: Efficacy and Safety Of Transcatheter Embolizationmentioning

confidence: 99%

“…The details and outcomes of the reviewed studies are listed in Table 1 [13,[32][33][34][35][36][37][38].…”

Section: Efficacy and Safety Of Transcatheter Embolizationmentioning

confidence: 99%

Section: Efficacymentioning

confidence: 99%

Section: Efficacymentioning

confidence: 99%

Section: Table 1 Summary Of Published Reports Of Transcatheter Embolmentioning

confidence: 99%

See 3 more Smart Citations

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

Takenaga

Aizawa

2017

Interventional Radiology

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Hepatic Encephalopathy: Classification, Diagnosis, and Treatment

Dhiman

Rathi

2019

Evidence‐based Gastroenterology and Hepatology 4e

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Embolization of portosystemic shunts for treatment of medically refractory hepatic encephalopathy

Lynn¹,

Singh

Congly

et al. 2016

Liver Transpl

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Treatment options for refractory hepatic encephalopathy (HE) are limited. Patients who fail medical management may harbor large portosystemic shunts (PSSs) which are possible therapeutic targets. This study aims to describe patient selection, effectiveness, and safety of percutaneous PSS embolization in those with medically refractory HE. A retrospective evaluation of consecutive adult patients with medically refractory HE referred for PSS embolization at a tertiary center was performed (2003–2015). Patient data collected included the type of HE, medications, Model for End-Stage Liver Disease (MELD) score, shunt type, embolization approach, and materials used. Outcomes of interest were immediate (7 days), intermediate (1–4 months), and longer-term (6–12 months) effectiveness and periprocedural safety. Effectiveness was determined based on changes in hospitalization frequency, HE medications, and symptoms. Twenty-five patients with large PSS were evaluated for shunt embolization. Five were excluded due to high MELD scores (n = 1), comorbid conditions (n = 1), or technical considerations (n = 3). Of 20 patients who underwent embolization, 13 had persistent and 7 had recurrent HE; 100% (20/20) achieved immediate improvement. Durable benefit was achieved in 100% (18/18) and 92% (11/12) at 1–4 and 6–12 months, respectively. The majority (67%; 8/12) were free from HE-related hospitalizations over 1 year; 10% developed procedural complications, and all resolved. Six developed new or worsening ascites. In conclusion, PSS embolization is a safe and effective treatment strategy that should be considered for select patients with medically refractory HE.

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Percutaneous transvenous embolization for portosystemic shunts associated with encephalopathy: Long‐term outcomes in 14 patients

Abstract: PTE could be one of the useful treatment options for PSE.

Cited by 31 publications

References 29 publications

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

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

Hepatic Encephalopathy: Classification, Diagnosis, and Treatment

Embolization of portosystemic shunts for treatment of medically refractory hepatic encephalopathy

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