Splenic vein embolization as a feasible treatment for patients with hepatic encephalopathy related to large spontaneous splenorenal shunts

Ke, Qiao; Wang, Zhiyong; Huang, Xin; Li, Ling; Wei, Weimin; Qiu, Linbin; Jiao, Yubin; Xie, Yixing; Peng, Xiaosong; Liu, Jingfeng; Guo, Wenping

doi:10.1016/j.aohep.2022.100725

Cited by 5 publications

(7 citation statements)

References 37 publications

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“…Alternatives such as CARTO and PARTO have yielded comparable outcomes with a lower incidence of adverse effects 24 , 31 . Another strategic approach involves selective SVE, which serves as a paradigm of preserving the shunt while effecting disconnection between the portal and systemic circulations 22 , 32 . This approach can help reduce HE recurrence; however, its application is restricted to patients with splenorenal shunts 22 , 32 .…”

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy associated with spontaneous portosystemic shunts

Ke,

He,

Cai

et al. 2024

Sci Rep

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This study aimed to assess the safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy (HE) associated with large spontaneous portosystemic shunts (SPSS). Inverse probability of treatment weighting (IPTW) was employed to minimize potential bias. A total of 123 patients were included in this study (34 in the embolization group and 89 in the control group). In the unadjusted cohort, the embolization group demonstrated significantly better liver function, a larger total area of SPSS, and a higher percentage of patients with serum ammonia levels > 60 µmol/L and the presence of hepatocellular carcinoma (HCC) (all P < 0.05). In the IPTW cohort, baseline characteristics were comparable between the two groups (all P > 0.05). Patients in the embolization group exhibited significantly longer HE-free survival compared to the control group in both the unadjusted and IPTW cohorts (both P < 0.05). Subsequent subgroup analyses indicated that patients with serum ammonia level > 60 μmol/L, hepatopetal flow within the portal trunk, the presence of solitary SPSS, a baseline HE grade of II, and the absence of HCC at baseline showed statistically significant benefit from embolization treatment (all P < 0.05). No early procedural complications were observed in the embolization group. The incidence of long-term postoperative complications was comparable to that in the control group (all P > 0.05). Hence, interventional embolization appears to be a safe and effective treatment modality for cirrhotic patients with refractory HE associated with large SPSS. However, the benefits of embolization were discernible only in a specific subset of patients.

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Section: Discussionmentioning

confidence: 99%

“…Subsequently, the optimal embolization approach and material were selected based on the shunt type, anatomical location, and size of the SPSS. Of note, SVE is exclusively applicable to HE patients with splenorenal shunt 22 . Post-embolization, venography was performed again to confirm complete embolization of the shunt or the splenic vein.…”

Section: Methodsmentioning

confidence: 99%

Safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy associated with spontaneous portosystemic shunts

Ke,

He,

Cai

et al. 2024

Sci Rep

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“…It has been previously shown that in some situations, there is a need to ligate spontaneous portosystemic shunts at the time of transplantation to avoid portal flow steal [ 5 , 6 ]. An attempt to recreate portal flow and splenorenal shunt embolization is an effective procedure when performed with expertise in interventional radiology in consultation with transplant surgery [ 7 ]. This is the first reported case of recreation of portal flow through stent placement from the native portal vein stump to the transplant portocaval shunt to re-establish portal vein flow before attempting splenorenal shunt embolization.…”

Section: Discussionmentioning

confidence: 99%

A Challenging Case of Refractory Hepatic Encephalopathy in a Postliver Retransplant Patient with Thrombosed Portal Vein: A Shunt for a Shunt

Salama

Leyson

Shah

et al. 2023

Case Reports in Hepatology

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Hepatic encephalopathy (HE) is a frequent and serious complication of chronic liver disease. The mechanism of hepatic encephalopathy is not entirely clear. Hepatic encephalopathy is defined as brain dysfunction caused by liver insufficiency and/or portal-systemic blood shunting. It manifests as a wide spectrum of neurological or psychiatric abnormalities, ranging from subclinical alterations, detectable only by neuropsychological or neurophysiological assessment, to coma. Liver transplant (LT) is the definitive treatment for refractory hepatic encephalopathy. In this case, we present a challenging case of refractory hepatic encephalopathy in a postliver transplant patient with portal vein thrombosis and a splenorenal shunt treated with a novel technique to address his complex anatomy.

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“…In turn, SPSS can be utilized as a potential avenue to treat patients with this type of HE. Previous studies have found that shunt embolization or splenic vein embolization can reduce the recurrence of HE related to SPSS [20][21][22], but attention should also be paid to the procedural complications, such as the deterioration of EGV, retention of ascites, and the formation of new collateral vessels [20,22].…”

Section: Discussionmentioning

confidence: 99%

“…Up to now, the main indications for intervention in patients with SPSS include recurrent or persistent HE, gastric variceal bleeding sustained by gastrorenal shunts [29,30]. The most common interventional therapies include shunt embolization, splenic vein embolization, and balloonoccluded retrograde transvenous obliteration [20,22,30]. Patients are indicated for these interventions after they suffer from symptoms associated with SPSS, and the value of interventions at the time of imaging ndings of SPSS remains to be determined.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous portosystemic shunt as a potiential marker for severe liver damage and high risk of complications associated with portal hypertension in patients with hepatitis B-related cirrhosis: a multicenter study from China

Wang

Huang³

et al. 2022

Preprint

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Background and aim Patients with cirrhosis have a high prevalence of spontaneous portosystemic shunt (SPSS), but it remains controversial whether the presence of SPSS is associated with liver function and portal hypertension (PHT)-related complications. In this study, we aimed to investigate the prevalence, clinical characteristics and related factors of SPSS in cirrhotic patients. Methods Patients who were diagnosed with hepatitis B-related cirrhosis between Jan 2020 and Oct 2021 were retrospectively recruited from five centers in China. All eligible patients were classified into SPSS and non-SPSS groups and their clinical characteristics were compared. Logistic regression analyses were performed to identify clinical characteristics associated with SPSS, and then to assess the independent impact of SPSS on the risk of PHT-related complications. Results Of the 1282 patients included in this study, SPSS was identified in 488 patients (38.1%). SPSS group had a higher proportion of patients with hepatofugal flow in portal vein, thinner diameter of right branch of portal vein (RPV), thicker diameter of left branch of portal vein (LPV), splenic vein (SV) and superior mesenteric vein (SMV), more severe liver function impairment, higher incidence and severity of esophageal and gastric varices (EGV), and a higher prevalence of PHT-related complications [EGV bleeding (EGVB), portal vein thrombosis (PVT), hepatic encephalopathy (HE), ascites, and hepatocellular carcinoma (HCC)] (all P < 0.05). On multivariable logistic regression analyses, MELD score, diameter of RPV and SV, hepatofugal flow in portal vein, EV or GV or EGV on radiological evaluation, presence of EGVB, PVT, HE, and moderate–severe ascites were independently associated with SPSS (all P < 0.05). In addition, presence of SPSS was identified as an independent risk factor for EGVB, PVT and HE (all P < 0.05). Conclusion SPSS may indicate severe liver damage and a high risk of PHT-related complications.

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Splenic vein embolization as a feasible treatment for patients with hepatic encephalopathy related to large spontaneous splenorenal shunts

Cited by 5 publications

References 37 publications

Safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy associated with spontaneous portosystemic shunts

Safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy associated with spontaneous portosystemic shunts

A Challenging Case of Refractory Hepatic Encephalopathy in a Postliver Retransplant Patient with Thrombosed Portal Vein: A Shunt for a Shunt

Spontaneous portosystemic shunt as a potiential marker for severe liver damage and high risk of complications associated with portal hypertension in patients with hepatitis B-related cirrhosis: a multicenter study from China

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