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Updated: Jul 25, 2026
Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure
Published on: September 13, 2014
Long-term outcomes of plug-assisted retrograde transvenous obliteration (PARTO) for refractory hepatic encephalopathy
Dong Ii Gwon1, Gun Ha Kim2, Hee Ho Chu2
1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Republic of Korea. radgwon@amc.seoul.kr.
Objectives:
To evaluate the efficacy and long-term outcomes of plug-assisted retrograde transvenous obliteration (PARTO) for the treatment of medically refractory hepatic encephalopathy (HE).
Materials And Methods:
Fifty-eight patients with cirrhosis who presented with one or more types of large portosystemic shunt (PSS) between April 2009 and March 2023 and had a history of at least two episodes of recurrent HE in the preceding 6 months were included in this retrospective study. Clinical follow-up included venous ammonia and West Haven (WH) score assessment. Technical and long-term outcomes were reviewed and analyzed.
Results:
The technical success rate was 98.3% (57 of 58 patients). The mean procedure time was 29 min (range, 9-114 min). The immediate clinical success rate was 98.3%. The median WH score improved significantly from 2 (range, 1-3) pre-PARTO to 0 (range, 0-1) post-PARTO (p < 0.001). The mean serum ammonia level, which was 82.4 µmol/dL ± 46 before PARTO, decreased significantly to 23.7 µmol/dL ± 17 within 1 week after PARTO (p < 0.001). Long-term follow-up data were available for only 48 patients because of early death (n = 2), follow-up loss (n = 2), or liver transplantation (n = 5). The obliteration rate of PSS was 100%. Nine (18.8%) patients experienced recurrence of HE at a mean of 19.6 months (range 1.5-32.8 months). The cumulative 1-, 2-, 3-, 5-, and 10-year recurrence rates of HE were 6.4%, 14.9%, 27.5%, 27.5%, and 27.5%, respectively. The median transplantation-free survival time was 45.7 months (95% confidence interval, 25-66.5 months).
Conclusion:
High clinical success rate and low recurrence rate of HE during the long-term follow-up period suggest that PARTO is an effective treatment for refractory HE due to PSS in patients with liver cirrhosis.
Key Points:
Question The efficacy and long-term outcomes of plug-assisted retrograde transvenous obliteration for patients with hepatic encephalopathy have not yet been strictly determined. Findings The clinical symptoms of hepatic encephalopathy completely resolved in 57 (98.3%) of 58 patients within 2 days after plug-assisted retrograde transvenous obliteration. Clinical relevance Long-term outcomes suggest that plug-assisted retrograde transvenous obliteration is an effective treatment for refractory hepatic encephalopathy due to portosystemic shunt in patients with liver cirrhosis.
