Therapeutic embolization of intrahepatic portosystemic shunts by retrograde transcaval catheterization

Abstract

A 57-year-old woman presented with hepatic encephalopathy, cirrhosis, and a dual-channel portosystemic venous shunt (PSVS). The shunt was treated successfully by embolization with steel coils via retrograde systemic venous access. Encephalopathy resolved. This new approach is considered safer than the previously reported percutaneous transhepatic route or the mesenteric venous route, requiring a mini-laparotomy.

Asymptomatic Aneurysmal Portosystemic Venous Shunt: A Case Report and Review of the Literature

“…Some authors postulates a persistent venous anastomosis such as ductus venosus and right vitelline vein. Others advocate an acquired cause from rupture of a portal venous aneurysm into the hepatic vein or from a dilated heptic vein communicating with the inferior vena cava via inferior phrenic and suprarenal vein (5,10,14,19,21,28,29). Persistent ductus venosus could be a remote possibility in our case.…”

“…Retrograde transcaval obliterationis the least invasive technique and is recommended as the first choice for treatment of portosystemic venous shunt except in patients with multiple shunts. Surgical intervention such as shunt ligation anf hepatic resection, creation of an alternative portsystemic shunt are additional therapeutic approach descibed in literature (6,17,21,26,31).…”

Oral glutamine challenge and magnetic resonance spectroscopy in three patients with congenital portosystemic shunts

“…The pathophysiological abnormalities that lead to neurological manifestations have not been established but appear to be similar to those that cause hepatic encephalopathy in cirrhosis [4]. A key factor is the access of portal blood to the systemic circulation, as demonstrated by the fact that the closure of the shunts can completely reverse the neurological manifestations [5,6].…”

Transvenous Embolization of Patent Ductus Venosus in Two Adult Cases

“…With occlusion of the shunt, the portal venous pressure usually increases within several days. Since surgical management of patent DV can be quite problematic 4) , several percutaneous techniques have been used to treat the associated portosystemic shunt [10][11][12][13][14][21][22][23] , including placement of steel coils, a detachable balloon, a handmade Z stent covered with a graft, a reduction stent to decrease shunt volume and embolic materials such as autologous thrombin, cyanoacrylate, fibrin glue, and EO. There are three reports on transcatheter procedures for the treatment of patients with patent DV.…”