Results of Portosystemic Shunt Embolization in Selected Patients with Cirrhosis and Recurrent Hepatic Encephalopathy

Choudhary, Narendra S.; Saigal, Sanjiv; Baijal, Sanjay Saran; Kumar, Amit; Saraf, Neeraj; Jain, Deepak Kumar; Jain, Vaibhav; Khandelwal, Anubhav; Kapoor, Ankur; Puri, Rajesh; Sud, Randhir; Soin, Arvinder S.

doi:10.1016/j.jceh.2017.01.028

Cited by 5 publications

(9 citation statements)

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“…A significant reduction in serum ammonia was noted with no recurrence of encephalopathy in any of these patients. 17 However, there are very few reports of these techniques in patients after liver transplantation. Baimakhanov et al 18 reported a case of a 52-year-old LDLT recipient with a large SMV-IVC PSS.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular management of portal steal syndrome due to portosystemic shunts after living donor liver transplantation

Jajodia

Khandelwal

et al. 2021

JGH Open

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Background and Aim: After liver transplant, pre-existent porto-systemic shunts (PSS) may persist, causing "portal steal," leading to graft dysfunction, hepatic encephalopathy (HE), and eventual rejection. In recipients of small-for-size transplant liver grafts, shunts may be created intraoperatively, facilitating diversion of portal flow to systemic circulation to avoid ill-effects of portal overperfusion. These iatrogenic shunts may also subsequently lead to portal steal. We aim to evaluate safety and efficacy of endovascular techniques in management of portal steal due to PSSs in living donor liver transplantation (LDLT) recipients. Methods: Between 2013 and 2020, we encountered five LDLT recipients with large PSS, who presented with graft dysfunction and/or HE. One patient had a surgically created shunt and four had spontaneous shunts, not surgically ligated during transplant. Endovascular techniques including plug-assisted or balloon-occluded retrograde transvenous obliteration (PARTO/BRTO) or covered inferior vena cava (IVC) stent grafts were to occlude these PSS and counter the portal steal in all patients. Technical success and clinical outcomes at 1-year-follow-up were assessed. Results: Imaging showed large PSS causing portal steal syndrome in all five patients. IVC stent graft was used to isolate the shunt in two patients and PARTO/BARTO was performed in three patients. One patient had guarded prognosis due to multiple organ dysfunction and died 5 days after endovascular procedure. At 1-year follow up, graft functions normalized in four patients with no recurrence of HE. No procedurerelated complications were seen. Conclusion: Endovascular techniques can be safely and effectively used to counter portal steal syndrome in LDLT recipients, thus avoiding surgical re-exploration in these patients.

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Section: Discussionmentioning

confidence: 99%

“…In another study from our Institute, 17 five patients with cirrhosis underwent BRTO or PARTO for recurrent HE and the presence of lieno‐renal ( n = 4) or meso‐caval shunts ( n = 1). Sclerosant was used in two patients, endovascular occlusion plugs in two patients, and a combination of both in one patient.…”

Section: Discussionmentioning

confidence: 99%

Endovascular management of portal steal syndrome due to portosystemic shunts after living donor liver transplantation

Jajodia

Khandelwal

et al. 2021

JGH Open

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“…Generally, balloon-occluded retrograde transvenous obliteration (BRTO) is effective for managing solitary gastric varices or recurrent hepatic encephalopathy with a portosystemic shunt (17,18). Furthermore, there are some data showing that BRTO improves the liver function via an increase in the portal venous flow volume after shunt occlusion (17,19).…”

Section: Discussionmentioning

confidence: 99%

The First Case of Coil Embolization for Left Gastric Vein Aneurysm with Liver Cirrhosis: A Case Report and Review of the Literature

et al. 2021

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We herein report the first case of interventional radiology for a left gastric vein aneurysm with a gastrorenal shunt. The etiology of the aneurysm was considered secondary to portal hypertension and liver cirrhosis due to hepatitis B virus infection. As the aneurysm was asymptomatic but had a tendency to expand, we successfully performed coil embolization for the aneurysm through a gastrorenal shunt.

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“…6). 3,[22][23][24][25] Pooled analysis of the published Indian studies revealed survival rate at 1 year among patients undergoing BRTO of 97% (95% CI: 0.91 to 1.0) and 98% (95% CI:0.89 to 1.0) by fixed and random effect models, respectively (►Fig. 7).…”

Section: Discussionmentioning

confidence: 99%

“…7). 3,[22][23][24][25] To our knowledge, there are two other large studies from the Indian subcontinent, describing the role of BRTO in patients with bleeding GVs or HE. 3,25 The sclerosant used by authors in both these studies was a mixture of air, STS, and lipiodol in a ratio 3:2:1.…”

Section: Discussionmentioning

confidence: 99%

Retrograde Transvenous Obliteration of Gastric Varices using Sodium Tetradecyl Sulphate: Technical Considerations and Results from a Single Institution Retrospective Study

Khera

Garg

Tiwari

et al. 2021

Journal of Clinical Interventional Radiology ISVIR

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Introduction Retrograde transvenous obliteration (RTO) with the assistance of a balloon (BRTO) or a vascular plug (PARTO) is an established method for treating gastric varices (GVs) secondary to portal hypertension. Most of the available studies on RTO have used lipiodol along with sclerosing agents like ethanolamine oleate or sodium tetradecyl sulfate (STS). We evaluated the safety and efficacy of RTO for treating GVs using STS as a sclerosant without lipiodol. Materials and Methods Sixteen patients (nine men, age range 16–74 years) were included in this retrospective study. Twelve patients presented with acute bleeding, two with chronic bleeding, one with large varices without bleeding, and one with refractory hepatic encephalopathy (HE). BRTO was attempted in 14 patients and PARTO in 2 patients. The technical and clinical success and complications of RTO were studied. Results The RTO procedure was technically successful in 14 (14/16, 87.5%) patients, with 13 (13/14, 93%) obtaining clinical success. One patient died due to the early recurrence of bleeding. Three patients had minor intraprocedural complications. Conclusion Retrograde gastric variceal obliteration using STS is safe and technically feasible with high technical and clinical success and low complication rate.

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Results of Portosystemic Shunt Embolization in Selected Patients with Cirrhosis and Recurrent Hepatic Encephalopathy

Cited by 5 publications

References 0 publications

Endovascular management of portal steal syndrome due to portosystemic shunts after living donor liver transplantation

Endovascular management of portal steal syndrome due to portosystemic shunts after living donor liver transplantation

The First Case of Coil Embolization for Left Gastric Vein Aneurysm with Liver Cirrhosis: A Case Report and Review of the Literature

Retrograde Transvenous Obliteration of Gastric Varices using Sodium Tetradecyl Sulphate: Technical Considerations and Results from a Single Institution Retrospective Study

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