Splenic Vein Embolization Using Coil Anchors and Prophylactic Occlusion of a Hepatofugal Collateral for Hepatic Encephalopathy due to Splenorenal Shunt: Technical Note and Literature Review
Purpose. Interventional treatment strategies for patients with encephalopathy due to splenorenal shunt remain controversial. Portosplenic blood flow separation by occluding the splenic vein could avoid the complication of severe portal hypertension, but it would require repeated reintervention due t...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | Case Reports in Radiology |
| Online Access: | http://dx.doi.org/10.1155/2013/160653 |
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| author | Masayoshi Inoue Toshihiro Tanaka Hiroyuki Nakagawa Tetsuya Yoshioka Kimihiko Kichikawa |
| author_facet | Masayoshi Inoue Toshihiro Tanaka Hiroyuki Nakagawa Tetsuya Yoshioka Kimihiko Kichikawa |
| author_sort | Masayoshi Inoue |
| collection | DOAJ |
| description | Purpose. Interventional treatment strategies for patients with encephalopathy due to splenorenal shunt remain controversial. Portosplenic blood flow separation by occluding the splenic vein could avoid the complication of severe portal hypertension, but it would require repeated reintervention due to recurrence of symptoms. This paper describes occlusion of the splenic vein using coil anchors and prophylactic embolization of a collateral hepatofugal vessel with no recurrence of hyperammonemia. Materials and Methods. A 51-year-old woman with severe cirrhosis had hepatic encephalopathy due to a large splenorenal shunt. The serum ammonia level was 132 μg/dL. Via a transileocolic approach, the splenic vein was completely embolized with 0.035-inch metallic coils using coil anchors while preserving the splenorenal shunt. In addition, one of the collateral vessels of the portal vein, the retrogastric vein, was also embolized prophylactically. Results. After this procedure, the serum ammonia level decreased immediately to 24 μg/dL. The portal venous pressure increased by only 1.5 mmHg. Hepatic encephalopathy had not been observed for 25 months after the procedure, and neither retention of ascites nor worsening of esophageal varices and liver function was observed. Conclusion. This procedure appears to be safe and effective for hepatic encephalopathy caused by a splenorenal shunt. |
| format | Article |
| id | doaj-art-7b4b0adfa9154ac29554468387b7c0a8 |
| institution | Kabale University |
| issn | 2090-6862 2090-6870 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Radiology |
| spelling | doaj-art-7b4b0adfa9154ac29554468387b7c0a82025-02-03T01:09:35ZengWileyCase Reports in Radiology2090-68622090-68702013-01-01201310.1155/2013/160653160653Splenic Vein Embolization Using Coil Anchors and Prophylactic Occlusion of a Hepatofugal Collateral for Hepatic Encephalopathy due to Splenorenal Shunt: Technical Note and Literature ReviewMasayoshi Inoue0Toshihiro Tanaka1Hiroyuki Nakagawa2Tetsuya Yoshioka3Kimihiko Kichikawa4Department of Radiology, Nara Prefectural Nara Hospital, 1-38-1 Hiramatu, Nara 631-0846, JapanDepartment of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, JapanDepartment of Radiology, Nara Prefectural Nara Hospital, 1-38-1 Hiramatu, Nara 631-0846, JapanDepartment of Radiology, Narumi Hospital, 19 Shinagawa-cho, Hirosaki 036-8183, JapanDepartment of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, JapanPurpose. Interventional treatment strategies for patients with encephalopathy due to splenorenal shunt remain controversial. Portosplenic blood flow separation by occluding the splenic vein could avoid the complication of severe portal hypertension, but it would require repeated reintervention due to recurrence of symptoms. This paper describes occlusion of the splenic vein using coil anchors and prophylactic embolization of a collateral hepatofugal vessel with no recurrence of hyperammonemia. Materials and Methods. A 51-year-old woman with severe cirrhosis had hepatic encephalopathy due to a large splenorenal shunt. The serum ammonia level was 132 μg/dL. Via a transileocolic approach, the splenic vein was completely embolized with 0.035-inch metallic coils using coil anchors while preserving the splenorenal shunt. In addition, one of the collateral vessels of the portal vein, the retrogastric vein, was also embolized prophylactically. Results. After this procedure, the serum ammonia level decreased immediately to 24 μg/dL. The portal venous pressure increased by only 1.5 mmHg. Hepatic encephalopathy had not been observed for 25 months after the procedure, and neither retention of ascites nor worsening of esophageal varices and liver function was observed. Conclusion. This procedure appears to be safe and effective for hepatic encephalopathy caused by a splenorenal shunt.http://dx.doi.org/10.1155/2013/160653 |
| spellingShingle | Masayoshi Inoue Toshihiro Tanaka Hiroyuki Nakagawa Tetsuya Yoshioka Kimihiko Kichikawa Splenic Vein Embolization Using Coil Anchors and Prophylactic Occlusion of a Hepatofugal Collateral for Hepatic Encephalopathy due to Splenorenal Shunt: Technical Note and Literature Review Case Reports in Radiology |
| title | Splenic Vein Embolization Using Coil Anchors and Prophylactic Occlusion of a Hepatofugal Collateral for Hepatic Encephalopathy due to Splenorenal Shunt: Technical Note and Literature Review |
| title_full | Splenic Vein Embolization Using Coil Anchors and Prophylactic Occlusion of a Hepatofugal Collateral for Hepatic Encephalopathy due to Splenorenal Shunt: Technical Note and Literature Review |
| title_fullStr | Splenic Vein Embolization Using Coil Anchors and Prophylactic Occlusion of a Hepatofugal Collateral for Hepatic Encephalopathy due to Splenorenal Shunt: Technical Note and Literature Review |
| title_full_unstemmed | Splenic Vein Embolization Using Coil Anchors and Prophylactic Occlusion of a Hepatofugal Collateral for Hepatic Encephalopathy due to Splenorenal Shunt: Technical Note and Literature Review |
| title_short | Splenic Vein Embolization Using Coil Anchors and Prophylactic Occlusion of a Hepatofugal Collateral for Hepatic Encephalopathy due to Splenorenal Shunt: Technical Note and Literature Review |
| title_sort | splenic vein embolization using coil anchors and prophylactic occlusion of a hepatofugal collateral for hepatic encephalopathy due to splenorenal shunt technical note and literature review |
| url | http://dx.doi.org/10.1155/2013/160653 |
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