Successful embolization of an intrahepatic portosystemic shunt using balloon-occluded retrograde transvenous obliteration: A case report

doi:10.12998/wjcc.v10.i6.2023

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Feb 26, 2022; 10(6): 2023-2029
Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.2023

Successful embolization of an intrahepatic portosystemic shunt using balloon-occluded retrograde transvenous obliteration: A case report

Hidemasa Saito, Satoru Murata, Fumie Sugihara, Tatsuo Ueda, Daisuke Yasui, Izumi Miki, Hiromitsu Hayashi, Shin-Ichiro Kumita

Hidemasa Saito, Fumie Sugihara, Tatsuo Ueda, Daisuke Yasui, Izumi Miki, Hiromitsu Hayashi, Shin-Ichiro Kumita, Department of Radiology, Nippon Medical School, Tokyo 113-8602, Japan

Satoru Murata, Center for Interventional Radiology, Teikyo University Chiba Medical Center, Chiba 299-0011, Japan

Author contributions: Saito H and Murata S treated the patient, reviewed the literature, and contributed to manuscript drafting; Sugihara F, Ueda T, Yasui D, and Miki I participated in the patient treatment and analyzed and interpreted the imaging findings; Hayashi H and Kumita SI critically reviewed the manuscript; all authors issued final approval for the version to be submitted.

Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Hidemasa Saito, MD, PhD, Assistant Professor, Department of Radiology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan. hide-saito@nms.ac.jp

Received: September 4, 2021
Peer-review started: September 4, 2021
First decision: November 7, 2021
Revised: November 16, 2021
Accepted: January 14, 2022
Article in press: January 14, 2022
Published online: February 26, 2022
Processing time: 172 Days and 6.4 Hours

Abstract

BACKGROUND

A congenital intrahepatic portosystemic shunt (IPSVS) is a rare vascular abnormality that is characterized by an anomalous intrahepatic venous tract that connects the intrahepatic portal vein with the hepatic venous system. Hepatic encephalopathy is an indication for IPSVS embolization, which is technically challenging because rapid blood flow through shunts can induce the migration of embolization material to systemic veins. This case report discusses the efficacy of percutaneous balloon-occluded retrograde transvenous obliteration for treating patients with IPSVSs.

CASE SUMMARY

A 75-year-old woman presented with a six-month history of repeated hepatic encephalopathy due to an IPSVS without liver cirrhosis. We successfully embolized the IPSVS using percutaneous balloon-occluded retrograde transvenous obliteration with interlocking detachable coils. After the procedure, the patient exhibited no symptoms of hepatic encephalopathy for 14 mo.

CONCLUSION

Balloon-occluded retrograde transvenous obliteration with detachable coils can be effective for the endovascular treatment of an IPSVS.

Keywords: Hepatic veins; Portal vein; Hepatic encephalopathy; Endovascular procedures; Embolization; Therapeutic; Case report

Core Tip: Portosystemic venous shunts are generally formed in patients with hepatic fibrosis and cirrhosis due to portal hypertension. Adult cases of congenital intrahepatic portosystemic shunt (IPSVS) are extremely rare. Hepatic encephalopathy is an indication for IPSVS embolization. Minimally invasive treatments that use interventional techniques, such as transcatheter embolization, are being utilized increasingly recently; however, shunt embolization is technically challenging because rapid blood flow through shunts can induce the migration of embolization material to systemic veins. Balloon-occluded retrograde transvenous obliteration with detachable coils can be effective for the endovascular treatment of an IPSVS.