Interventional radiologic treatment for idiopathic portal hypertension

Hirota, Shun; Ichikawa, Satoshi; Matsumoto, Shinichi; Motohara, Tomofumi; Fukuda, Tsuyoshi; Yoshikawa, Takeshi

doi:10.1007/s002709900394

Cited by 41 publications

(21 citation statements)

References 11 publications

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“…In addition to treatment of splenic rupture, SAE may be performed to manage hypersplenism, treat portal hypertension, or improve hepatic perfusion after liver transplantation. 9,10 In our case, although initial SAE was highly effective in obtaining immediate hemostasis to stabilize his vital signs, a few more sessions of SAE was required for control recurrent bleeding. This might be because the coagulopathy worsened owing to massive bleeding after the splenic rupture, compromising the embolic effect of the initial SAE.…”

Section: Discussionmentioning

confidence: 87%

Spontaneous splenic rupture due to extensive venous malformation with consumptive coagulopathy: treatment with splenic artery embolization

et al. 2010

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Extensive venous malformation (VM) is often associated with chronic consumptive coagulopathy, which may result in bleeding complications. We report herein the case of a 25-year-old man with extensive VM involving the left lower extremity who presented with hypovolemic shock and abdominal distension without abdominal trauma. Abdomen computed tomography revealed splenic rupture with massive hemoperitoneum. He was managed successfully by repeated splenic artery embolization.

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Section: Discussionmentioning

confidence: 87%

Spontaneous splenic rupture due to extensive venous malformation with consumptive coagulopathy: treatment with splenic artery embolization

et al. 2010

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“…EIS and, recently, EVL were adopted as alternative methods for management of esophageal varices, and in Japan approximately 80% of patients were scheduled for these treatment procedures [19,21]. Since 1990s, interventional radiological treatment (partial splenic embolization, transjugular intrahepatic portosystemic shunt, and percutaneous transhepatic obliteration) was used to treat esophageal varices and hypersplenism in patients with IPH [22,23]. Despite the relatively small number of patients treated by interventional radiology, the authors believed that these methods represent an alternative treatment option for patients who refuse surgery or show diffuse portal thrombosis upon initial diagnosis [22].…”

Section: Discussionmentioning

confidence: 99%

“…Since 1990s, interventional radiological treatment (partial splenic embolization, transjugular intrahepatic portosystemic shunt, and percutaneous transhepatic obliteration) was used to treat esophageal varices and hypersplenism in patients with IPH [22,23]. Despite the relatively small number of patients treated by interventional radiology, the authors believed that these methods represent an alternative treatment option for patients who refuse surgery or show diffuse portal thrombosis upon initial diagnosis [22]. According to the previous reports [1,3,19], surgical treatment has been reserved for cases with failure of EIS or EVL controlling of esophageal varices and symptomatic hypersplenism.…”

Section: Discussionmentioning

confidence: 99%

“…The prognosis of IPH is generally good if an effective prophylaxis and management of esophageal variceal bleeding take place [1,9]. Treatment options for esophageal varices in patients with IPH recently have become more diverse and include portal decompression procedures [4,6,10,11], devascularization procedures and splenectomy [12][13][14][15][16][17][18], endoscopic injection sclerotherapy (EIS) or variceal ligation (EVL) [6,[19][20][21], and interventional radiology [22,23]. To date, no clear consensus has been reached concerning the best method for treatment of esophageal varices due to IPH.…”

Section: Introductionmentioning

confidence: 99%

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Idiopathic Portal Hypertension: Report of a Case

Mishin¹

2005

Visc Med

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Background: Idiopathic portal hypertension (IPH), the socalled Banti’s syndrome, is a condition clinically characterized by splenomegaly, hypersplenism, and increased portal pressure. IPH is uncommon in the Western world. In this article we report on a well-documented case of this rare form of disorder. Case Report: A 27-year-old woman was referred to our hospital with symptoms of severe pancytopenia, massive splenomegaly, and moderate esophageal varices with red color signs despite endoscopic variceal ligation. Upon admission, the hepatic functional reserve was satisfactory (Child-Pugh class A). The color-Doppler ultrasound showed an anatomically normal and non-thrombotic splenoportal venous axis. A complete gastroesophageal devascularization with splenectomy (Hassab-Paquet procedure) was performed. Intraoperatively the liver looked grossly normal while the microscopic examination revealed an inflammatory cell infiltration and fibrosis of the portal tract but no signs of liver cirrhosis. The final diagnosis of IPH was made based on the definitions adopted by the Japan IPH Study Committee. The patient has been asymptomatic for 12 months postoperatively, and hematological indices reached their normal values. The esophageal varices were eradicated. Conclusion: The literature on treatment strategies of esophageal varices due to IPH was reviewed with particular reference to the role of devascularization procedures and splenectomy in the management of this rare condition.

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“…58,59 Splenic artery embolization, percutaneous transhepatic obliteration, and a transjugular intrahepatic portosystemic shunt (TIPSS) are other options in the primary prevention of variceal bleeding. 60 The role of surgery is limited to those who fail to respond to endoscopic therapy. 61 Selective shunts, like distal splenorenal shunts, are preferred due to a low incidence of postshunt encephalopathy.…”

Section: Managementmentioning

confidence: 99%

Noncirrhotic Portal Hypertension

Rajekar¹,

Vasishta²,

Chawla³

et al. 2011

Journal of Clinical and Experimental Hepatology

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Portal hypertension is characterized by an increase in portal pressure (> 10 mmHg) and could be a result of cirrhosis of the liver or of noncirrhotic diseases. When portal hypertension occurs in the absence of liver cirrhosis, noncirrhotic portal hypertension (NCPH) must be considered. The prognosis of this disease is much better than that of cirrhosis. Noncirrhotic diseases are the common cause of portal hypertension in developing countries, especially in Asia. NCPH is a heterogeneous group of diseases that is due to intrahepatic or extrahepatic etiologies. In general, the lesions in NCPH are vascular in nature and can be classified based on the site of resistance to blood flow. In most cases, these disorders can be explained

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Interventional radiologic treatment for idiopathic portal hypertension

Abstract: Interventional radiological treatment is effective for patients with idiopathic portal hypertension, whether or not they have undergone surgery.

Cited by 41 publications

References 11 publications

Spontaneous splenic rupture due to extensive venous malformation with consumptive coagulopathy: treatment with splenic artery embolization

Spontaneous splenic rupture due to extensive venous malformation with consumptive coagulopathy: treatment with splenic artery embolization

Idiopathic Portal Hypertension: Report of a Case

Noncirrhotic Portal Hypertension

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