Spontaneous thrombosis of large splenorenal shunt during balloon-occluded retrograde transvenous obliteration in a patient with chronic persistent hepatic encephalopathy. Is this catheter assisted trans-venous occlusion?

  • Lijesh Kumar Department of Diagnostic and Interventional Radiology, PVS Institute of Digestive Diseases, PVS Memorial Hospital, Kochi, Kerala, India.
  • Cyriac Abby Philips | abbyphilips@gmail.com Department of Hepatology and Transplant Medicine, PVS Institute of Digestive Diseases, PVS Memorial Hospital, Kochi, Kerala, India.
  • Prakash Zacharias Department of Gastroenterology, PVS Institute of Digestive Diseases, PVS Memorial Hospital, Kochi, Kerala, India.
  • Sudarshan Patil Department of Gastroenterology, PVS Institute of Digestive Diseases, PVS Memorial Hospital, Kochi, Kerala, India.
  • Philip Augustine Department of Hepatology and Transplant Medicine and Department of Gastroenterology, PVS Institute of Digestive Diseases, PVS Memorial Hospital, Kochi, Kerala, India.

Abstract

Large spontaneous portosystemic shunts in cirrhosis are implicated in recurrent and/or chronic persistent hepatic encephalopathy. In long standing cases, these shunts lead to portal vein thrombosis and hepatic dysfunction. Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular technique that is usually employed for shunt closure in the patients manifesting the features of chronic hepatic encephalopathy. There are several reports documenting systemic and portal vein thrombosis as a part of the procedure. We report first time a patient in whom the difficult and partial BRTO procedure led to the extensive thrombosis of the large splenorenal shunt itself without sclerosant instillation.

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Published
2017-12-13
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Section
Case Reports
Keywords:
cirrhosis, portal hypertension, portosystemic shunts, hepatic encephalopathy, BRTO, shunt occlusion
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How to Cite
Kumar, L., Philips, C., Zacharias, P., Patil, S., & Augustine, P. (2017). Spontaneous thrombosis of large splenorenal shunt during balloon-occluded retrograde transvenous obliteration in a patient with chronic persistent hepatic encephalopathy. Is this catheter assisted trans-venous occlusion?. Gastroenterology Insights, 8(1). https://doi.org/10.4081/gi.2017.6906