Successful Portal-Systemic Shunt Occlusion with Balloon-occluded Retrograde Transvenous Obliteration for Portosystemic Encephalopathy without Liver Cirrhosis

Successful portal-systemic shunt occlusion of a direct shunt between the inferior mesenteric vein and inferior vena cava with balloon-occluded retrograde transvenous obliteration following recanalization after placing a covered stent in the portal and superior mesenteric veins

“…4,17 This method is also used for obliterating portal-systemic shunts. 7,8 There have been many reports about obstructing the portal-systemic shunt wherein the hyperammonemia and clinical symptoms were alleviated in patients with hepatic encephalopathy. [7][8][9]13,15,16 In our patient, liver function was preserved before the procedure.…”

“…Nowadays, less invasive endovascular procedures have been advocated as alternatives to surgical ligation. [5][6][7][8][9][12][13][14][15][16] In Japan, BRTO is widely accepted for obliterating gastric varices with the transvenous approach. 4,17 This method is also used for obliterating portal-systemic shunts.…”

“…[4][5][6] Direct communication between the inferior mesenteric vein (IMV) and the inferior vena cava (IVC) is relatively rare. [7][8][9][10] We were asked to treat a patient with a direct communication between the IMV and the IVC that had caused refractory hepatic encephalopathy. First, we inserted a covered stent in the main trunk of the portal vein and the superior mesenteric vein (SMV) to block the hepatofugal fl ow from the SMV and the hepatopetal fl ow from the splenic vein.…”

Portosystemic Encephalopathy without Liver Cirrhosis Masquerading as Depression

“…According to our literature review, 24 cases of portosystemic encephalopathy without liver cirrhosis have been reported, including 20 from East Asia (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) and four from the USA (16)(17)(18)(19), since Raskin et al reported the first case in 1964 (16). Previous studies involved mostly women (83%), with a mean age of 67.5 years (range: 37-86 years).…”

Portosystemic shunt occlusion with balloon-occluded retrograde transvenous obliteration improve refractory hepatic encephalopathy

“…Thus, shunt closure is a natural interventional target for relief of encephalopathy symptoms. Since its introduction, BRTO has been shown to be a suitable therapeutic option for patients with portosystemic encephalopathy due to various types of extrahepatic portosystemic shunts [5,6]. In conclusion, refractory hepatic encephalopathy to medical management often improve by BRTO.…”