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Successful embolization using interlocking detachable coils for a congenital extrahepatic portosystemic venous shunt
Takuji Yamagami1, Rika Yoshimatsu, Tomohiro Matsumoto
1Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo, Kyoto 602-8566, Japan. yamagami@koto.kpu-m.ac.jp
Insights
A congenital extrahepatic portosystemic venous shunt in a child caused hyperammonemia. Successful embolization of the shunt resolved the condition, offering a potential treatment for similar cases.
Area of Science:
- Interventional Radiology
- Pediatric Gastroenterology
- Vascular Surgery
Background:
- Congenital extrahepatic portosystemic venous shunts are rare vascular anomalies.
- Hyperammonemia can be a serious complication of these shunts, particularly in pediatric patients.
- Effective management strategies are crucial for improving patient outcomes.
Observation:
- A 6-year-old boy presented with hyperammonemia due to an 18 mm congenital extrahepatic portosystemic venous shunt.
- The shunt connected the inferior mesenteric vein to the left internal iliac vein with rapid flow.
- Initial management involved balloon-assisted flow reduction to facilitate intervention.
Findings:
- Transcatheter embolization of the shunt was successfully performed using interlocking detachable coils and microcoils.
- The procedure was completed without any complications.
- The patient's hyperammonemia resolved rapidly post-embolization.
Implications:
- Percutaneous embolization is a safe and effective treatment for congenital extrahepatic portosystemic venous shunts causing hyperammonemia.
- This minimally invasive approach offers a viable alternative to surgical intervention.
- Successful treatment can lead to rapid resolution of hyperammonemia and improved quality of life in affected children.
Abstract:
The authors report the case of a 6-year-old boy with a congenital extrahepatic portosystemic venous shunt. He had hyperammonemia. The shunt was 18 mm in diameter and located between the inferior mesenteric vein and the left internal iliac vein. The flow in the shunt was very rapid. After decreasing blood flow by inflating a balloon catheter inserted into the left internal iliac vein from the femoral vein, a microcatheter was coaxially advanced to the shunt to embolize the shunt. Embolization was successfully performed with interlocking detachable coils and microcoils without any complication. This patient's hyperammonemia resolved soon after the procedure.
