Surgical ligation of a portosystemic shunt for the treatment of type II Abernethy malformation in 12 children

Abstract Background: Surgical ligation and endovascular embolization have been recommended for type II congenital extrahepatic portosystemic shunt (CEPS); however, no consensus has been reached. This study was designed to compare the safety and efficacy of surgical ligation and endovascular embolization for the treatment of type II CEPS. Methods: In this retrospective study, 23 consecutive patients diagnosed with type II CEPS between March 2011 and April 2019 were divided into either a surgical group (n=13; 41.5±19.9years) or the interventional group (n =10; 44.9±19.7years). The surgical group underwent laparoscopic surgical ligation of the shunt alone or ligation of the shunt and splenic artery and/or vein. The interventional group underwent endovascular embolization using microcoils, detachable coils and vascular plug. Results: All 23 patients received a one-step shunt closure, and their clinical symptoms were significantly improved within 3 months post-procedure and without recurrence during follow-up. The serum ammonia levels in both groups decreased after the procedure and dropped to normal level at 6 to 12 months post-procedure. Compared with baseline, the portal vein diameter in interventional group increased significantly at 3-, 6-, 12-, and 36-month post-occlusion (P=0.01 for all). The procedure time was shorter in interventional group (127.0±43.2minutes) than surgical group (219.8±56.7minutes; P <0.001). The intraoperative blood loss in interventional group (32.0±62.5mL) was less than that in surgical group (238.5±396.9mL; P=0.001).Conclusion: Both surgical ligation and endovascular embolization are effective in the treatment of type II CEPS. Endovascular embolization has the advantages of shorter procedure time, and less intraoperative blood loss. The ligation of the portosystemic shunt and splenic artery and vein is feasible with apparent safety, and it could avoid a second surgical treatment.

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Surgical Ligation for the Treatment of an Unusual Presentation of Type II Abernethy Malformation

Annals of Vascular Surgery ◽

10.1016/j.avsg.2019.10.094 ◽

2020 ◽

Vol 65 ◽

pp. 285.e1-285.e5

Author(s):

Mantian Zhou ◽

Juqiang Zhang ◽

Lei Luo ◽

Botian Wang ◽

Renjun Zheng ◽

...

Keyword(s):

Unusual Presentation ◽

Type Ii ◽

Abernethy Malformation ◽

Surgical Ligation

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Abernethy malformation type II with nephrotic syndrome and other multisystemic presentation: an illustrative case for understanding pathogenesis of extrahepatic complication of congenital portosystemic shunt

Human Pathology ◽

10.1016/j.humpath.2012.08.018 ◽

2013 ◽

Vol 44 (3) ◽

pp. 432-437 ◽

Cited By ~ 6

Author(s):

David F. Schaeffer ◽

Simin Laiq ◽

Hyun-Jung Jang ◽

Rohan John ◽

Oyedele A. Adeyi

Keyword(s):

Nephrotic Syndrome ◽

Portosystemic Shunt ◽

Illustrative Case ◽

Type Ii ◽

Abernethy Malformation ◽

Congenital Portosystemic Shunt

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Efficacy and Safety of Surgical Ligation versus Endovascular Embolization for Type II Congenital Extrahepatic Portosystemic Shunt

BioMed Research International ◽

10.1155/2021/9951393 ◽

2021 ◽

Vol 2021 ◽

pp. 1-13

Author(s):

Jinlong Zhang ◽

Weidong Duan ◽

Zhuting Fang ◽

Maoqiang Wang ◽

Li Cui ◽

...

Keyword(s):

Splenic Artery ◽

Endovascular Embolization ◽

Portosystemic Shunt ◽

Type Ii ◽

Intraoperative Blood Loss ◽

Procedure Time ◽

Surgical Ligation ◽

Congenital Extrahepatic Portosystemic Shunt ◽

Interventional Group ◽

Surgical Group

Objective. To evaluate the safety and efficacy of surgical ligation and endovascular embolization for the treatment of type II congenital extrahepatic portosystemic shunt (CEPS). Methods. In this retrospective study, 23 patients diagnosed with type II CEPS between March 2011 and April 2019 were divided into either a surgical group ( n = 13 ; 41.5 ± 19.9 years) or the interventional group ( n = 10 ; 44.9 ± 19.7 years). The surgical group underwent laparoscopic surgical ligation of the shunt alone or ligation of the shunt and splenic artery and/or vein. The interventional group underwent endovascular embolization using microcoils, detachable coils, and vascular plug. Results. All 23 patients received a one-step shunt closure, and their clinical symptoms were significantly improved within 3-month postprocedure and without recurrence during follow-up. The serum ammonia levels in both groups decreased after the procedure and dropped to normal level at 6- to 12-month postprocedure. Compared with baseline, the portal vein diameter in interventional group increased significantly at 3-, 6-, 12-, and 36-month postocclusion ( P = 0.01 for all). The procedure time was shorter in the interventional group ( 127.0 ± 43.2 minutes) than the surgical group ( 219.8 ± 56.7 minutes; P < 0.001 ). The intraoperative blood loss in the interventional group ( 32.0 ± 62.5 mL) was less than that in the surgical group ( 238.5 ± 396.9 mL; P = 0.001 ). Conclusion. Both surgical ligation and endovascular embolization are effective in the treatment of type II CEPS. Endovascular embolization has the advantages of shorter procedure time and less intraoperative blood loss. The ligation of the portosystemic shunt and splenic artery and vein is feasible with apparent safety, and it could avoid a second surgical treatment.

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Type II Congenital Portosystemic Shunt: Consideration for Endovascular Closure

10.1055/s-0041-1730612 ◽

2019 ◽

Author(s):

Shadi Saleem

Keyword(s):

Portosystemic Shunt ◽

Type Ii ◽

Congenital Portosystemic Shunt

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Abernethy Malformation Type II and Concurrent Nodular Hyperplasia in a Rare Female Case

Case Reports in Radiology ◽

10.1155/2018/6501490 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Zhen Kang ◽

Xiangde Min ◽

Liang Wang

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Type I ◽

Type Ii ◽

Malignant Tumours ◽

Abernethy Malformation ◽

Vascular Abnormality ◽

Female Case ◽

Nodular Hyperplasia ◽

The Right

Background. Abernethy malformation is a rare splanchnic vascular abnormality characterizing extrahepatic abnormal shunts that is classified into types I and II. Abernethy malformation type I has a female predilection and is associated with a variety of concurrent hepatic benign or malignant tumours while type II with concurrent tumours is very rare in females. Case Report. We report a rare female case of Abernethy malformation type II with concurrent occupying lesion in the right liver, which was successfully transplanted; the occupying lesion was pathologically proven to be nodular hyperplasia. Conclusion. This case might provide further knowledge regarding Abernethy malformation. On imaging, the anatomy of portal vein should be carefully investigated to categorize Abernethy malformation, and a wide variety of differential diagnosis of concurrent occupying lesions should be taken into account.

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