Clinical study of modified partial splenic artery embolization in the treatment of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

GAO Feng; HUANG Xiangzhong

doi:10.7619/jcmp.20231771

Journal of Clinical Medicine in Practice > 2023 > 27(14): 95-98. > DOI: 10.7619/jcmp.20231771

GAO Feng, HUANG Xiangzhong. Clinical study of modified partial splenic artery embolization in the treatment of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt[J]. Journal of Clinical Medicine in Practice, 2023, 27(14): 95-98. DOI: 10.7619/jcmp.20231771

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Clinical study of modified partial splenic artery embolization in the treatment of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

GAO Feng,
HUANG Xiangzhong^,

Department of Intervention, Jiangyin Hospital Affiliated to Medical College of Southeast University, Jiangyin, Jiangsu, 214400

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Received Date: May 31, 2023
Revised Date: June 15, 2023
Available Online: July 30, 2023

Graphical Abstract

Abstract

Abstract

Objective
To observe the effect of modified partial splenic artery embolization(MPSE) in the treatment of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt(TIPS).
Methods
A retrospective analysis was performed for 10 patients with hepatic encephalopathy after TIPS treated with MPSE. Liver function indexes, main portal vein flow velocity and shunt flow velocity were compared before and 3 and 6 months after operation were compared.
Results
All patients successfully completed the MPSE, and postoperative symptoms of abdominal pain occurred in 1 case, but no obvious surgery-related symptoms and complications were found in other cases. During the six-month postoperative follow-up, only 1 case of hepatic encephalopathy was not controlled. There were no significant differences in alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), albumin (ALB) and main portal vein blood flow velocity at 3 and 6 months after operation (P>0.05). There were significant differences in shunt flow velocity 3 and 6 months after operation (P < 0.05).
Conclusion
MPSE can reduce the shunt blood flow velocity after TIPS, and has the functions of flow limiting, thereby effectively controlling hepatic encephalopathy.

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References (21)

References

[1]	CASADABAN L C, PARVINIAN A, MINOCHA J, et al. Clearing the confusion over hepatic encephalopathy after TIPS creation: incidence, prognostic factors, and clinical outcomes[J]. Dig Dis Sci, 2015, 60(4): 1059-1066. doi: 10.1007/s10620-014-3391-0
[2]	RIGGIO O, NARDELLI S, MOSCUCCI F, et al. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt[J]. Clin Liver Dis, 2012, 16(1): 133-146. doi: 10.1016/j.cld.2011.12.008
[3]	LEE E W, KUEI A, SAAB S, et al. Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt[J]. World J Gastroenterol, 2016, 22(25): 5780-5789. doi: 10.3748/wjg.v22.i25.5780
[4]	STEPANOVA M, MISHRA A, VENKATESAN C, et al. In-hospital mortality and economic burden associated with hepatic encephalopathy in the United States from 2005 to 2009[J]. Clin Gastroenterol Hepatol, 2012, 10(9): 1034-1041, e1. doi: 10.1016/j.cgh.2012.05.016
[5]	HADJIHAMBI A, ARIAS N, SHEIKH M, et al. Hepatic encephalopathy: a critical current review[J]. Hepatol Int, 2018, 12(Suppl 1): 135-147.
[6]	中华医学会肝病学分会. 肝硬化肝性脑病诊疗指南[J]. 临床肝胆病杂志, 2018, 34(10): 2076-2089. doi: 10.3969/j.issn.1001-5256.2018.10.007
[7]	孙宾, 林世海, 罗磊, 等. 脾动脉分支血管直径比值法计算脾脏栓塞体积百分比的临床应用[J]. 中国介入影像与治疗学, 2017, 14(8): 468-471. doi: 10.13929/j.1672-8475.201701036
[8]	GARCIA-TSAO G, ABRALDES J G, BERZIGOTTI A, et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65(1): 310-335. doi: 10.1002/hep.28906
[9]	中国医师协会介入医师分会. 中国门静脉高压经颈静脉肝内门体分流术临床实践指南(2019版)[J]. 中华医学杂志, 2019, 99(45): 3534-3546. doi: 10.3760/cma.j.issn.0376-2491.2019.45.003
[10]	PERRY B C, KWAN S W. Portosystemic shunts: stable utilization and improved outcomes, two decades after the transjugular intrahepatic portosystemic shunt[J]. J Am Coll Radiol, 2015, 12(12 Pt B): 1427-1433.
[11]	BUREAU C, THABUT D, OBERTI F, et al. Transjugular intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites[J]. Gastroenterology, 2017, 152(1): 157-163. doi: 10.1053/j.gastro.2016.09.016
[12]	NOLTE W, WILTFANG J, SCHINDLER C, et al. Portosystemic hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with cirrhosis: clinical, laboratory, psychometric, and electroencephalographic investigations[J]. Hepatology, 1998, 28(5): 1215-1225. doi: 10.1002/hep.510280508
[13]	张浩, 潘佳佳, 蒋晓芬, 等. 门静脉压力梯度预测TIPS术后高危人群肝性脑病的研究[J]. 中华肝脏病杂志, 2021, 29(1): 72-74. doi: 10.3760/cma.j.cn501113-20190716-00248
[14]	LUO S H, CHU J G, HUANG H, et al. Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy[J]. World J Gastroenterol, 2019, 25(9): 1088-1099. doi: 10.3748/wjg.v25.i9.1088
[15]	BAI M, HE C Y, QI X S, et al. Shunting branch of portal vein and stent position predict survival after transjugular intrahepatic portosystemic shunt[J]. World J Gastroenterol, 2014, 20(3): 774-785. doi: 10.3748/wjg.v20.i3.774
[16]	PEREIRA K, CARRION A F, SALSAMENDI J, et al. Endovascular management of refractory hepatic encephalopathy complication of transjugular intrahepatic portosystemic shunt (TIPS): comprehensive review and clinical practice algorithm[J]. Cardiovasc Interv Radiol, 2016, 39(2): 170-182. doi: 10.1007/s00270-015-1197-x
[17]	TAYLOR A G, KOLLI K P, KERLAN R K Jr. Techniques for transjugular intrahepatic portosystemic shunt reduction and occlusion[J]. Tech Vasc Interv Radiol, 2016, 19(1): 74-81. doi: 10.1053/j.tvir.2016.01.008
[18]	FANELLI F, SALVATORI F M, RABUFFI P, et al. Management of refractory hepatic encephalopathy after insertion of TIPS: long-term results of shunt reduction with hourglass-shaped balloon-expandable stent-graft[J]. AJR Am J Roentgenol, 2009, 193(6): 1696-1702. doi: 10.2214/AJR.09.2968
[19]	COOKSON D T, ZAMAN Z, GORDON-SMITH J, et al. Management of transjugular intrahepatic portosystemic shunt (TIPS)-associated refractory hepatic encephalopathy by shunt reduction using the parallel technique: outcomes of a retrospective case series[J]. Cardiovasc Intervent Radiol, 2011, 34(1): 92-99. doi: 10.1007/s00270-010-0016-7
[20]	MADOFF D C, WALLACE M J, AHRAR K, et al. TIPS-related hepatic encephalopathy: management options with novel endovascular techniques[J]. RadioGraphics, 2004, 24(1): 21-36. doi: 10.1148/rg.241035028
[21]	王彤, 赵卫, 胡继红, 等. 肝硬化脾功能亢进部分脾动脉栓塞术后严重并发症相关因素分析[J]. 介入放射学杂志, 2016, 25(7): 619-623. doi: 10.3969/j.issn.1008-794X.2016.07.018

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Clinical study of modified partial splenic artery embolization in the treatment of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

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