Plasma Glucose Level Is Predictive of Serum Ammonia Level After Retrograde Occlusion of Portosystemic Shunts

Abstract

Preoperative plasma glucose level is a useful predictor of clinically significant ammonia reduction resulting from occlusion of PSS in patients with cirrhosis. Even if PSS are present, control of blood ammonia levels by BRTO alone may be difficult in patients with glucose intolerance.

Comparison of patients with hepatic encephalopathy and those with gastric varices before and after balloon‐occluded retrograde transvenous obliteration

“…Balloon‐occluded retrograde transvenous obliteration was carried out using the method described by Kanagawa et al . and we followed a published procedural protocol . Briefly, after inserting an 8‐Fr catheter sheath introducer (Terumo, Tokyo, Japan) from the right femoral vein under local anesthesia, a 20‐mm diameter 6‐Fr occlusion balloon catheter (Terumo Clinical Supply Co., Gifu, Japan) was advanced as far as possible toward the periphery of the SRS or GRS through the left renal vein through the sheath introducer.…”

“…The wedged hepatic venous pressure (WHVP) was measured and the hepatic venous pressure gradient (HVPG) was calculated before the shunt vessels were occluded on the first day and immediately after checking for a stable thrombus on the second day, as previously described . The portal flow volume (PFV) was calculated using the portal flow velocity and the diameter of the main PV that was measured by Doppler ultrasonography (US) before and at 1 month after BRTO, as described previously .…”

Liver stiffness measured by transient elastography as predictor of prognoses following portosystemic shunt occlusion

“…The BRTO procedure was essentially performed using the method described by Kanagawa et al ., and the previously described procedural protocol was followed . Following the insertion of an 8‐Fr catheter sheath introducer (Terumo Corp., Tokyo, Japan) from the right femoral vein under local anesthesia, a 20‐mm‐diameter 6‐Fr occlusion balloon catheter (Terumo Clinical Supply Co., Gifu, Japan) was advanced as far as possible toward the periphery of the GRS or SRS via the left renal vein using the sheath introducer.…”

“…The wedged hepatic venous pressure was measured, and the hepatic venous pressure gradient was calculated on the first day before the shunt vessels were occluded and on the second day, immediately after checking for a stable thrombus . The portal flow volume (PFV) was calculated using portal flow velocity and diameter of the main portal vein that was measured by Doppler ultrasonography before and 1 month after BRTO .…”

A novel therapeutic strategy for esophageal varices using endoscopic treatment combined with splenic artery embolization according to the Child-Pugh classification

“…Before and immediately after PSE, the wedged hepatic venous pressure (WHVP) was measured and the hepatic venous pressure gradient (HVPG) was calculated, as described previously [18,19]. Briefly, the right hepatic venous branch was catheterized, and the free hepatic venous pressure and WHVP were measured using diluted contrast medium before and after vein occlusion, which was achieved by inflating a balloon catheter (Terumo Clinical Supply Co., Ltd., Gifu, Japan).…”