Author information

• ¹Department of Gastroenterology and Hepatology, Section of Liver and Biliopancreatic Disorders, University Hospitals Leuven, KU Leuven, Leuven, Belgium. wim.laleman@uzleuven.be.
• ²Medizinische Klinik B, Universitätsklinikum Münster, Münster University, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. wim.laleman@uzleuven.be.
• ³Medizinische Klinik B, Universitätsklinikum Münster, Münster University, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
• ⁴Department of Gastroenterology and Hepatology, University Hospital of South Denmark, Esbjerg, Denmark.
• ⁵Department of Radiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
• ⁶Department of Gastroenterology and Hepatology, Section of Liver and Biliopancreatic Disorders, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
• ⁷European Foundation of Chronic Liver Failure, EFCLIF, Barcelona, Spain.

Abstract

Spontaneous portosystemic shunts (SPSS) are an often neglected cause of hepatic encephalopathy associated with cirrhosis. Nowadays, SPSS are considered as radiological biomarkers of clinically significant portal hypertension rather than the previous dogmatic perceived decompressive vessels. SPSS are not rare as they can be diagnosed in over 60% of the patients with cirrhosis by mere contrast-enhanced CT. Moreover, they are clinically relevant since they impact on all portal hypertensive related complications, in particular medically refractory HE, and represent an independent predictor of decompensation and mortality in cirrhosis, irrespective of the type of SPSS. Taken together, these elements warrant strategies to target these shunts directly which is currently is achieved via interventional radiology embolization. In this review, we discuss why it makes sense to tackle SPSS, how to do it and what it takes to do it right based on aggregated literature.