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- W4385187789 abstract "Background and Aim: Chronic liver disease is rampant with varied underlying aetiologies. Decompensated cirrhotic patient frequently present with recurrent / refractory hepatic encephalopathy (HE) or life-threatening variceal bleed secondary to portosystemic shunts (PSS). The development of portal-systemic shunts is precisely the central pathophysiological event, with increase in the shunt size correlating with persistent encephalopathy. PSS are considered radiological biomarkers of clinically significant portal hypertension. Treatment options for refractory HE are limited and when medical therapy fails, endovascular/percutaneous embolization are often indicated with high success rate and minimal complications compared to surgical ligation. Methods: Consequent to portal hypertension secondary cirrhosis, acquired portosystemic shunts can be seen in intrahepatic and extrahepatic locations. Results: Large shunts causing significant HE or variceal bleed are predominantly extrahepatic, and can be found in remote, uncommon locations. Based on the location, either antegrade approach like Balloon occluded antegrade transvenous obliteration (BATO) via TIPS/percutaneous portal vein access and retrograde approach via transjugular or transfemoral approach for balloon-occluded retrograde transvenous obliteration (BRTO) is performed. Bases on the size and reflux within the shunts, the embolizing agent can be sclerosis agents (STS), glue or gelfoam in BRTO, plugs in PARTO and coils in CARTO. We describe both common and uncommon locations of these PSS on imaging, with special emphasis on various radiological intervention techniques. Conclusion: Portosystemic shunts can lead to life threatening variceal bleed or moribund hepatic encephalopathy. Imaging plays a vital role in identifying these shunts, and radiological interventions play a major role with high success and low complication rate when endoscopic interventions fail." @default.
- W4385187789 created "2023-07-25" @default.
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- W4385187789 date "2023-01-01" @default.
- W4385187789 modified "2023-10-16" @default.
- W4385187789 title "Imaging and Endovascular Interventions for Portosystemic shunts in cirrhosis - An Overview" @default.
- W4385187789 doi "https://doi.org/10.1016/j.jceh.2023.07.278" @default.
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