Hepatic encephalopathy occurs in patients with severe liver dysfunction or a portosystemic shunt. In patients with hepatic encephalopathy caused by a portosystemic shunt, interventional closure of the shunt is essential. Transcatheter embolization is gaining popularity as a less invasive and highly effective procedure [1]. In this case report, the trans-hepatic embolization of a large portosystemic shunt is described as a treatment of choice for a patient with hepatic encephalopathy secondary to liver cirrhosis.

Porto-systemic shunts (PSS) are defined as abnormal connections between the portal venous circulation and systemic venous circulation. PSS result in hepatic encephalopathy as portal venous blood bypasses liver hepatocytes, resulting in an inability to metabolise ammonia. PSS may be congenital or acquired, with the most common acquired cause due to portal hypertension secondary to cirrhosis. Transcatheter embolisation of PSS aims to obliterate the PSS and improve portal venous flow through the liver parenchyma [1]. A 67-year-old female was brought in via ambulance to the Emergency...

A digital subtraction angiogram (DSA) study was performed via both a femoral vein approach (accessing the left renal vein) and a percutaneous trans-hepatic approach (accessing the portal veins). Large splenorenal varices were demonstrated (Figure 2). Using the trans-hepatic approach, embolisation coils and an Amplatzer plug were deployed in the splenorenal varices causing subsequent obliteration of the splenorenal varices (Figure 3). There were no post-procedural complications, and the patient was discharged home with marked symptomatic improvement when reassessed one month later.

Transcatheter embolisation of PSS is gaining popularity as a treatment for patients with recurrent or refractory hepatic encephalopathy secondary to large PSS that is refractory to medical management. This may be approached via a percutaneous trans-hepatic approach (as in our case) or, less commonly, a trans-ileocolic vein approach[1, 2]. Worldwide, transcatheter embolisation of large PSS for hepatic encephalopathy has been shown to be efficacious, with high rates of technical success (reported from 86-100%)[1, 4, 5] and clinical success (reported from 85.7-100% in the short term)...

Takenaga, S. & Aizawa, Y. (2017). Efficacy and Safety of Transcatheter Embolization for Hepatic Encephalopathy Caused by Spontaneous Portosystemic Shunts. Interventional Radiology. 2. 51-58. 10.22575/interventionalradiology.2016-0010. Tanoue, S., Kiyosue, H., Komatsu, E., Hori, Y., Maeda, T., Mori, H. (2003). Symptomatic intrahepatic portosystemic venous shunt: embolization with an alternative approach. American Journal of Roentgenology; 181: 71-78. Zidi, S., Zanditenas, D., Gelu-Simeon, M., Rangheard, A., Valla, D., Vilgrain,V. (2007). Treatment of chronic portosystemic encephalopathy in cirrhotic patients by embolization of portosystemic shunts. Liver International; 27: 1389-1393. Laleman, W.,...