Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima 734-8551, Japan.
To evaluate the clinical outcome of percutaneous transvenous embolization (PTE) for portal-systemic shunt (PSS) associated with encephalopathy
METHODS: Fourteen patients with portal-systemic encephalopathy (PSE) were enrolled in this retrospective cohort study. We evaluated technical success, clinical success, complication, and outcomes.
PSSs in the main causes of PSEs were including spleno-renal shunts in three, gastro-renal shunts in four, superior mesenteric vein-systemic shunts in four, inferior mesenteric vein-systemic shunt in one, and main trunk of portal vein-inferior vena cava shunts in two patients, respectively. We used only ethanolamine oleate (EO) in five, EO and coils in five, EO, coils and n-butyl 2-cyanoacrylate (NBCA) in two, coils and NBCA in two patients as embolic materials. The rate of primary- and secondary technical success was 93 % (13/14 patients) and 100 %. No major complications were encountered related to PTE. Follow up periods was median 27 months (range; 12-79 months). All patients had sustained disappearance of PSE. One patient occurred recurrence of PSE caused by another PSS development. Thus, clinical success was achieved in 93 % (13/14 patients). The ammonia levels one year later after PTE were significantly improved compared with pre-PTE (median; 102 vs. 41 μmol/l) and maintained lower levels 2 and 3 years later. Child-Pugh scores were no changed significantly. Esophageal varices were aggravated in 29 % (4/14 patients). Five patients were dead, but no death of hepatic failure related to PTE was encountered.
PTE could be one of the useful treatment options for PSE.