Comparison of Surgical Ligation and Endovascular Embolization in the Management of Type II Congenital Extrahepatic Portosystemic Shunt: A Retrospective Clinical Study

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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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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Congenital Portosystemic Shunt: Our Experience

Case Reports in Pediatrics ◽

10.1155/2015/691618 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Tiziana Timpanaro ◽

Stefano Passanisi ◽

Alessandra Sauna ◽

Claudia Trombatore ◽

Monica Pennisi ◽

...

Keyword(s):

Multidisciplinary Approach ◽

Case Reports ◽

Endovascular Embolization ◽

Portosystemic Shunt ◽

Type Ii ◽

Systemic Vein ◽

Congenital Portosystemic Shunt ◽

Congenital Extrahepatic Portosystemic Shunt ◽

Case Presentations ◽

Rule Out

Introduction. Congenital portosystemic venous malformations are rare abnormalities in which the portal blood drains into a systemic vein and which are characterized by extreme clinical variability.Case Presentations. The authors present two case reports of a congenital extrahepatic portosystemic shunt (Type II). In the first patient, apparently nonspecific symptoms, such as headache and fatigue, proved to be secondary to hypoglycemic episodes related to the presence of a portosystemic shunt, later confirmed on imaging. During portal vein angiography, endovascular embolization of the portocaval fistula achieved occlusion of the anomalous venous tract. In the second patient, affected by Down’s syndrome, the diagnosis of a portosystemic malformation was made by routine ultrasonography, performed to rule out concurrent congenital anomalies. Because of the absence of symptoms, we chose to observe this patient.Conclusions. These two case reports demonstrate the clinical heterogeneity of this malformation and the need for a multidisciplinary approach. As part of a proper workup, clinical evaluation must always be followed by radiographic diagnosis.

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A Type II Congenital Extrahepatic Portosystemic Shunt: A Rare Cause of Abdominal Pain Diagnosed by Point-of-Care Ultrasound

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2016.12.038 ◽

2017 ◽

Vol 52 (6) ◽

pp. 880-882

Author(s):

Sun Hwa Lee ◽

Seong Jong Yun

Keyword(s):

Abdominal Pain ◽

Point Of Care ◽

Portosystemic Shunt ◽

Point Of Care Ultrasound ◽

Type Ii ◽

Congenital Extrahepatic Portosystemic Shunt

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Born Again: Recurrent Hepatic Encephalopathy in an Adult without Cirrhosis

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0039-1686966 ◽

2019 ◽

Vol 02 (01) ◽

pp. 039-040

Author(s):

Tom George ◽

Sasidharan Rajesh ◽

Cyriac Abby Philips

Keyword(s):

Hepatic Encephalopathy ◽

Systemic Circulation ◽

Portosystemic Shunt ◽

Type Ii ◽

Adult Onset ◽

Significant Clinical Improvement ◽

Congenital Extrahepatic Portosystemic Shunt ◽

Born Again

AbstractCongenital extrahepatic portosystemic shunt (CEPS) develops between the por-to-mesenteric and systemic veins. The splanchnic venous system drains directly to systemic circulation in this condition. We present a case of an adult onset Type II CEPS presenting with hepatic encephalopathy. The patient underwent PARTO (plug-assisted retrograde transvenous obliteration) and had a significant clinical improvement on subsequent follow-up. Our case highlights the importance of imaging and the role of an interventional radiologist in the management of the condition.

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