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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
PubMed
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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).

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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.