Coil Embolization of Pulmonary Arteries as a Palliative Treatment of Diffuse Type I Hepatopulmonary Syndrome

Abstract

Hepatopulmonary syndrome is a serious complication of liver disease. Type I hepatopulmonary syndrome is associated with diffuse dilatation of the pulmonary vasculature, leading to severe hypoxemia. Liver transplantation is the treatment of choice for this condition. There are limited options for those who are not candidates for liver transplantation. We present the case of a patient who presented with severe hypoxemia requiring F IO 2 of 0.95 with P aO 2 of 59 mm Hg. Workup revealed 33% intrapulmonary right-to-left shunt. A pulmonary angiogram showed diffuse dilatation of the pulmonary arteries, especially in the lower lobes. The patient was diagnosed with type I hepatopulmonary syndrome. He was not a candidate for liver transplantation. The patient underwent sequential coil embolizations of the lower lobe pulmonary arteries. He was discharged home on 2 L of supplemental oxygen. This case demonstrates that coil embolization of dilated pulmonary arteries is a potential palliative treatment for patients with diffuse type I hepatopulmonary syndrome.

Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) „Komplikationen der Leberzirrhose“

“…Die chirurgische oder angiografische Sanierung portosystemischer Shunts mittels Ligatur, Embolisation oder Cavoplasty zeigte dagegen in nicht-zirrhotischen Patienten mit portaler Hypertension oder Budd-Chiari-Syndrom eine Besserung des HPS in mehreren Fallserien und kann bei entsprechender Konstellation erwogen werden [405]. Ebenso konnte in kleinen Fallserien ein palliativer Effekt einer Embolisation der intrapulmonalen Shunts demonstriert werden, für eine Empfehlung reicht aber die Datenlage derzeit noch nicht aus [429].…”

Improved survival in children with HPS: Experience from two high volume liver transplant centers across continents

“…We have seen this in‐patient number 24 with repeated transient improvements in oxygenation and subsequently reverting to hypoxemia after coil embolization and objective demonstration of new shunts on consecutive pulmonary angiogram. This suggests that correction of hypoxemia may actually stimulate new shunt formation 13 . Low‐grade hypoxia in high altitudes seems to be protective of the development of HPS due to vasoconstriction 14,15 …”

“…This suggests that correction of hypoxemia may actually stimulate new shunt formation. 13 Low-grade hypoxia in high altitudes seems to be protective of the development of HPS due to vasoconstriction. 14,15 It is likely that the new collateral vessel formation following embolisation, makes it easy for the blocked collateral vessels to re-distribute the flow and hasten the progression of HPS.…”

Therapeutic coil embolization of dominant shunt in hepatopulmonary syndrome enhances post‐liver transplant respiratory recovery

“…Coil embolization helps to improve hypoxemia in both type I and type II HPS vascular patterns 6,7 . It can be used as a bridge for patients who cannot undergo LT immediately.…”