Successful portal-systemic shunt occlusion of a direct shunt between the inferior mesenteric vein and inferior vena cava with balloon-occluded retrograde transvenous obliteration following recanalization after placing a covered stent in the portal and superior mesenteric veins

Abstract

Extrahepatic portal-systemic shunts cause portal-systemic encephalopathy. Direct communication between the inferior mesenteric vein (IMV) and the inferior vena cava (IVC) is a relatively rare pathway among the variety of portal-systemic shunts. This report describes a case of successful occlusion of an IMV-IVC shunt. Based on laboratory data and computed tomography findings, a 69-year-old woman with liver cirrhosis was diagnosed with portal-systemic encephalopathy due to a shunt between the IMV and the IVC. Her hepatic coma had not been adequately controlled by oral or intravenous pharmacotherapy. First, we placed a covered stent in the main trunk of the portal vein and the superior mesenteric vein (SMV) to block the SMV hepatofugal flow and splenic vein hepatopetal flow, but this therapy showed only a transient therapeutic effect due to recanalization. Next, we performed balloon-occluded retrograde transvenous obliteration (BRTO) of the portal-systemic shunt. After the BRTO, she has had no episodes of portal-systemic encephalopathy for 2 years.

The Promise of Percutaneous Transhepatic Variceal Embolization for Both Gastroesophageal and Ectopic Varices—An Australian Case Series

“…27,28 However, neither BRTO or PARTO can be performed if patients do not have a catheterizable gastrorenal shunt. 29,30 Furthermore, there are only a few scattered case reports on the use of BRTO for ectopic varices, [31][32][33][34][35][36] none of which include rectal varices. For these patients, PTVE can still be performed.…”

Successful embolisation of intrahepatic portosystemic venous shunt using AMPLATZER Vascular Plug II

“…A portal vein hepatic vein shunt (PV shunt) in the liver is a relatively rare abnormality 1 , 2 that can cause hyperammonaemia and neurological symptoms. 2 – 4 Previous studies reported little success when using conventional treatment with interventional radiological strategies. 2 This is because the blood flow at the site of a PV shunt is rapid, and coils placed at the PV shunt sometimes migrate out of the target site.…”