Treatment of chronic portosystemic encephalopathy in cirrhotic patients by embolization of portosystemic shunts

Zidi, S H; Zanditenas, David; Gelu-Siméon, Moana; Rangheard, A.-S.; Valla, Dominique; Vilgrain, Valérie; Pelletier, G

doi:10.1111/j.1478-3231.2007.01602.x

Cited by 39 publications

(49 citation statements)

References 18 publications

(33 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%

“…In addition, shunt occlusion leading to a rapid increase in portal pressure may induce serious complications, such as variceal bleeding and intractable ascites [13]. Thus, contraindications for transcatheter embolization include not only severe hepatic failure, but also uncontrolled variceal bleeding, refractory ascites, and severe coagulopathy.…”

Section: Indications and Contraindications 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 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%

“…However, the degree to which portal hypertension was exacerbated after the procedure and the amount of residual hepatic function differs considerably from patient-to-patient. Hence, not all patients benefit from shunt embolization [13,35].…”

Section: Efficacymentioning

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%

Section: Indications and Contraindications Of Transcatheter Embolizationmentioning

confidence: 99%

Section: Efficacymentioning

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%

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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Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: A multicenter survey on safety and efficacy

et al. 2013

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Refractory hepatic encephalopathy (HE) remains a major cause of morbidity in cirrhosis patients. Large spontaneous portosystemic shunts (SPSSs) have been previously suggested to sustain HE in these patients. We aimed to retrospectively assess the efficacy and safety of patients treated with embolization of large SPSSs for the treatment of chronic therapy-refractory HE in a European multicentric working group and to identify patients who may benefit from this procedure. Between July 1998 and January 2012, 37 patients (Child A6-C13, MELD [Model of Endstage Liver Disease] 5-28) with refractory HE were diagnosed with single large SPSSs that were considered eligible for embolization. On a short-term basis (i.e., within 100 days after embolization), 22 out of 37 patients (59.4%) were free of HE (P < 0.001 versus before embolization) of which 18 (48.6% of patients overall) remained HE-free over a mean follow-up period of 697 6 157 days (P < 0.001 versus before embolization). Overall, we noted improved autonomy, decreased number of hospitalizations, and severity of the worst HE episode after embolization in three-quarters of the patients. Logistic regression identified the MELD score as strongest positive predictive factor of HE recurrence with a cutoff of 11 for patient selection. As to safety, we noted one major nonlethal procedure-related complication. There was no significant increase in de novo development or aggravation of preexisting varices, portal hypertensive gastropathy, or ascites. Conclusion: This multicenter European cohort study demonstrated a role for large SPSSs in chronic protracted or recurrent HE and substantiated the effectiveness and safety of embolization of these shunts, provided there is sufficient functional liver reserve. (HEPATOLOGY 2013;57:2448-2457 H epatic encephalopathy (HE) is a major complication of cirrhosis and refers to potentially reversible alterations in autonomy, consciousness, behavior, and psychomotor functions related to an accumulation of toxins due to hepatocellular dysfunction and portosystemic shunting.1-5 While in some patients HE is initiated abruptly by a precipitating event such as infection or gastrointestinal bleeding (the so-called episodic HE), other patients have persistent HE characterized by continuous high levels of ammonia, chronic electrophysiological abnormalities, and recurrent or persistent incapacitating alterations in mental status, often without evident precipitating events. 1,3,4 In this latter group, medical treatment is Abbreviations: EASL-CLIF, European Association for the Study of the Liver -Consortium on Chronic Liver Insufficiency; HE, hepatic encephalopathy; MELD, Model of Endstage Liver Disease; mRS, modified Rankin Scale; SPSS, spontaneous portosystemic shunt; SRS, splenorenal shunt; TIPS, transjugular intrahepatic portosystemic shunt.From the

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et al. 2013

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Treatment of chronic portosystemic encephalopathy in cirrhotic patients by embolization of portosystemic shunts

Abstract: We believe that optimal management of these patients with chronic spontaneous encephalopathy is liver transplantation.

Cited by 39 publications

References 18 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

Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: A multicenter survey on safety and efficacy

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