Symptomatic intrahepatic portosystemic venous shunt: embolization with an alternative approach.

Abstract

Intrahepatic portosystemic venous shunt is relatively rare and not well recognized. Awareness of intrahepatic communications is important because they can cause encephalopathy, and most of these shunts can be completely cured by transcatheter embolization. In this study, we describe the angiographic findings and transcatheter embolization techniques using several approaches for the treatment of intrahepatic portosystemic venous shunt. Between 1989 and 2001, we treated 10 patients with symptomatic intrahepatic portosystemic venous shunt by performing transcatheter embolization with Gianturco coils, fibered platinum coils, detachable balloons, and detachable microcoils using one of three approaches to access the portal venous system: transileocolic obliteration (n = 2), percutaneous transhepatic obliteration (n = 4), or retrograde transcaval obliteration (n = 4). In all patients, complete obliteration or nearly complete obliteration was confirmed angiographically, and symptoms related to portal-systemic encephalopathy improved after treatment. Complications were observed in three patients: adhesive ileus in a patient treated by transileocolic obliteration and thrombosis of intrahepatic portal branches in two patients treated by percutaneous transhepatic obliteration. On angiography, two types of intrahepatic portosystemic venous shunt were seen: intrahepatic portal venous-hepatic venous communication and intrahepatic portal venous-perihepatic venous communication. Transcatheter embolization is effective for treatment of intrahepatic portosystemic venous shunt. Retrograde transcaval obliteration is the least invasive technique and is recommended as the first choice for treatment of portosystemic venous shunt except in patients with multiple shunts.