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Embolization to reverse severe recurrent hepatic encephalopathy
R Uflacker1, L A d'Albuquerque, A de Oliveira e Silva
1MED-IMAGEM, Hospital Beneficência Portuguesa, São Paulo.
Arquivos De Gastroenterologia
|January 1, 1988
Summary
Embolization procedures effectively controlled severe hepatic encephalopathy in patients with porto-systemic shunts. Both splenic and direct shunt embolization proved successful, offering new treatment options for refractory cases.
Area of Science:
- Interventional Radiology
- Hepatology
- Vascular Surgery
Background:
- Severe hepatic encephalopathy (HE) often presents in patients with porto-systemic shunts.
- Refractory HE cases require alternative treatment strategies beyond standard medical management.
Purpose of the Study:
- To evaluate the efficacy of embolization techniques in managing severe, treatment-resistant hepatic encephalopathy associated with porto-systemic shunts.
- To assess different embolization methods, including splenic and direct shunt embolization.
Main Methods:
- Angiographic examination of five patients with spontaneous (n=4) or surgically created (n=1) porto-systemic shunts.
- Interventions included two-thirds splenic embolization (n=2), percutaneous transhepatic portography with selective shunt embolization (n=2), and percutaneous transcaval embolization of a mesocaval shunt (n=1).
Main Results:
- Hepatic encephalopathy was controlled in all five patients following embolization procedures.
- Splenic embolization successfully managed HE in two patients with splenomegaly and spontaneous shunts.
- Direct shunt embolization (transhepatic or transcaval) also achieved successful control of HE.
Conclusions:
- Embolization of spontaneous porto-systemic shunts, particularly splenic embolization in cases with splenomegaly, is an effective treatment for severe hepatic encephalopathy.
- Direct embolization of porto-systemic shunts offers a viable and effective therapeutic option for controlling refractory hepatic encephalopathy.