Abstract
While balloon-occluded retrograde transvenous obliteration (B-RTO) is useful as a procedure for management of hepatic encephalopathy, ascites as well as esophageal varices may be aggravated in frequent due to elevation of portal venous pressure following complete obliteration of portosystemic shunts. Thus, usefulness of partial B-RTO procedures using a loose ball of non-fibered interlocking detachable coil (IDC) was retrospectively evaluated in patients with intractable hepatic encephalopathy. Subjects were 11 patients with portosystemic shunts carrying the left renal vain as a drainage vessel, and were classified into 6 patients receiving partial B-RTO procedures and 5 patients in whom conventional B-RTO procedures using 5% ethanolamine oleate iopamidol were done. Hepatic encephalopathy was attenuated in 5 among 6 patients receiving partial B-RTO procedures, while frequency of hepatic encephalopathy occurrence and duration of hospitalization were decreased in the remaining 1 patient. Serum ammonia levels were significantly decreased after the procedures compared to the baseline levels in both groups (p<0.05), and a reduction rate of the levels after the procedures relative to the baseline levels were 42.0% in the partial B-RTO group, which was equivalent to the rate (48.6%) in the conventional B-RTO group. In the conventional B-RTO group, intractable ascites developed in 1 patient and esophageal varices were aggravated leading to rupture in an another patient, while such complications were absent in all patients receiving partial B-RTO procedures. Partial B-RTO procedures may prevent development of overt hepatic encephalopathy through decrease of blood flow in portosystemic shunts without excess elevation of the portal venous pressure. In conclusion, partial B-RTO procedures were effective and safe as therapeutic devises for hepatic encephalopathy due to portosystemic shunts, and may contribute to improve quality of life of patients.
