Portosystemic Shunt Embolization and Recurrent Ascites: A Single-Center Case Series

Privitera, G.; Figorilli, Francesco; Jalan, Rajiv; Mehta, Gautam

doi:10.1053/j.gastro.2018.06.092

Cited by 10 publications

(7 citation statements)

References 7 publications

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“…In view of the increased risk of refractory HE in this population, our single-center experience supports the efficacy of the embolization of large PSS as a procedure for the treatment of refractory HE. In keeping with other reports, [4][5][6] we found significant neurologic improvement in patients undergoing the procedure. Unlike suggestions by other authors, we did not find an association between preprocedural MELD score and outcome, suggesting that a MELD score of >11 may not be an optimal method for stratification.…”

Section: Portosystemic Shunt Embolization and Recurrent Ascites: A Sisupporting

confidence: 92%

“…Those patients who also presented gastric varices type 2, according to Hosking and Johnson or Sarin, had a greater rate of bleeding. Taking into account the association between gastrorenal shunts and gastric varices, 5,6 also found in our cohort, 3 they suggest the possibility that b-blockers might have influenced our results.…”

Section: Portosystemic Shunt Embolization and Recurrent Ascites: A Sisupporting

confidence: 71%

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Portosystemic Shunt Embolization and Recurrent Ascites: A Single-Center Case Series

et al. 2018

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Section: Portosystemic Shunt Embolization and Recurrent Ascites: A Sisupporting

confidence: 92%

Section: Portosystemic Shunt Embolization and Recurrent Ascites: A Sisupporting

confidence: 71%

Portosystemic Shunt Embolization and Recurrent Ascites: A Single-Center Case Series

et al. 2018

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“…207 More recently, a single centre study suggested that although there was significant improvement in the severity of HE in the immediate post-embolisation period, most patients developed complications of portal hypertension or died during the following 12 months. 208 The currently available data suggest that shunt embolisation is a useful treatment modality for patients with cirrhosis and HE, but that it should be considered a bridge to transplantation in most cases.…”

Section: Specific Treatmentmentioning

confidence: 99%

Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy

Rose

Amodio

Bajaj

et al. 2020

Journal of Hepatology

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285

223

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Hepatic encephalopathy (HE) is a frequent and serious complication of both chronic liver disease and acute liver failure. HE manifests as a wide spectrum of neuropsychiatric abnormalities, from subclinical changes (mild cognitive impairment) to marked disorientation, confusion and coma. The clinical and economic burden of HE is considerable, and it contributes greatly to impaired quality of life, morbidity and mortality. This review will critically discuss the latest classification of HE, as well as the pathogenesis and pathophysiological pathways underlying the neurological decline in patients with end-stage liver disease. In addition, management strategies, diagnostic approaches, currently available therapeutic options and novel treatment strategies are discussed.

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“…Systemic hypertension was the most common comorbidity (N = 42, 91.3%), and 37 patients (80.4%) were overweight or obese. The baseline median of Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores were 7 (IQR 25-75 P, 7-9) and 15.5 (11)(12)(13)(14)(15)(16)(17)(18)(19), respectively. One large PSS was notable in 38 (82.6%) patients, while dual shunts were present in the rest.…”

Section: Patients Characteristicsmentioning

confidence: 99%

Clinical outcomes related to portal pressures before and after embolization of large portosystemic shunts in cirrhosis

Rajesh,

Philips,

Ahamed

et al. 2023

SAGE Open Medicine

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Objectives: Embolization of large portosystemic shunts effectively controls gastric variceal bleeding and prevents hepatic encephalopathy. The significance of dynamic changes in hepatic venous pressure gradient before and after embolization on clinical events and patient outcomes remains unknown. Methods: In this retrospective single-center series, 46 patients with gastric variceal bleeding, hepatic encephalopathy, or both undergoing embolization (January 2018 to October 2020) were included, and dynamic changes in portal pressures were analyzed against patient outcomes. Results: Males predominated. The most common portosystemic shunt syndrome was the lienorenal shunt. In all, 34 patients underwent embolization for hepatic encephalopathy and 11 for gastric variceal bleeding. The proportion of patients surviving at the end of 12 and 32 months was 86.96 and 54.35%, respectively. The hepatic venous pressure gradient before shunt embolization was 13.4 ± 3.2 and 16.9 ± 3.7 mm Hg after occlusion ( p < 0.001). Bleeding from varices on overall follow-up was notable in five patients (10.9%), and overt hepatic encephalopathy in four ( N = 42, 9.5%) patients at 6–12 months. The development of infections within 100 days and beyond the first year was associated with the risk of dying at the end of 12 and 32 months, respectively. Elevation of hepatic venous pressure gradient by >4 mm Hg from baseline and an absolute increase to >16 mm Hg immediately post-procedure significantly predicted the development of early- and late-onset ascites, respectively. Conclusion: Close monitoring for the development of infections and optimization of beta-blockers and diuretics after shunt embolization may improve clinical outcomes and help identify patients who will benefit from liver transplantation pending prospective validation.

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Portosystemic Shunt Embolization and Recurrent Ascites: A Single-Center Case Series

Cited by 10 publications

References 7 publications

Portosystemic Shunt Embolization and Recurrent Ascites: A Single-Center Case Series

Portosystemic Shunt Embolization and Recurrent Ascites: A Single-Center Case Series

Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy

Clinical outcomes related to portal pressures before and after embolization of large portosystemic shunts in cirrhosis

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