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Case Reports in Radiology
Volume 2013 (2013), Article ID 160653, 5 pages
http://dx.doi.org/10.1155/2013/160653
Case Report

Splenic Vein Embolization Using Coil Anchors and Prophylactic Occlusion of a Hepatofugal Collateral for Hepatic Encephalopathy due to Splenorenal Shunt: Technical Note and Literature Review

1Department of Radiology, Nara Prefectural Nara Hospital, 1-38-1 Hiramatu, Nara 631-0846, Japan
2Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara 634-8522, Japan
3Department of Radiology, Narumi Hospital, 19 Shinagawa-cho, Hirosaki 036-8183, Japan

Received 22 January 2013; Accepted 28 February 2013

Academic Editors: G. Bastarrika, E. Bölke, A. Komemushi, M. Sato, and D. Tsetis

Copyright © 2013 Masayoshi Inoue et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. Interventional treatment strategies for patients with encephalopathy due to splenorenal shunt remain controversial. Portosplenic blood flow separation by occluding the splenic vein could avoid the complication of severe portal hypertension, but it would require repeated reintervention due to recurrence of symptoms. This paper describes occlusion of the splenic vein using coil anchors and prophylactic embolization of a collateral hepatofugal vessel with no recurrence of hyperammonemia. Materials and Methods. A 51-year-old woman with severe cirrhosis had hepatic encephalopathy due to a large splenorenal shunt. The serum ammonia level was 132 μg/dL. Via a transileocolic approach, the splenic vein was completely embolized with 0.035-inch metallic coils using coil anchors while preserving the splenorenal shunt. In addition, one of the collateral vessels of the portal vein, the retrogastric vein, was also embolized prophylactically. Results. After this procedure, the serum ammonia level decreased immediately to 24 μg/dL. The portal venous pressure increased by only 1.5 mmHg. Hepatic encephalopathy had not been observed for 25 months after the procedure, and neither retention of ascites nor worsening of esophageal varices and liver function was observed. Conclusion. This procedure appears to be safe and effective for hepatic encephalopathy caused by a splenorenal shunt.