Selective embolization of the splenic vein for shunt-preserving disconnection of the portal and systemic circulation: report of two cases
This 50-year-old man with chronic hepatitis due to hepatitis C virus infection suffered from recurrent episodes of hepatic encephalopathy since undergoing transcatheter arterial chemoembolization for hepatocellular carcinoma 1 year earlier. He had repeated episodes of acute encephalopathy despite protein restriction and administration of lactulose and branched-chain amino acids and was admitted with hepatic encephalopathy (West Haven Criteria stage 4). His liver function was Child-Pugh B (total bilirubin, 1.9 mg/dl; albumin, 2.9 g/dl; prothrombin time, 94%; no ascites). The blood ammonia level was 333 µg/dl (normal range, 15–65 µg/dl). Contrast-enhanced computed tomography (CT) scans were acquired with a 64-row multidetector scanner (Brilliance-64, Philips Medical Systems, Best, The Netherlands) and 3D images revealed portosystemic shunts.