Filter-Assisted Shunt Embolization of Large Portosystemic Shunts: Technical Feasibility, Safety, and Outcomes.
Cardiovasc Intervent Radiol 2022;
45:1540-1546. [PMID:
35978173 DOI:
10.1007/s00270-022-03240-w]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/24/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE
To describe the feasibility and outcomes of filter-assisted shunt embolization in patients with acquired large portosystemic shunts.
METHODS
Two-center HIPAA compliant retrospective study of all patients who underwent filter-assisted shunt embolization between 03/2015-03/2021. Initial clinical evaluation, including demographic information, shunt sizing, and procedural details, was reviewed. Technical success was defined as successful occlusion of the targeted shunt.
RESULTS
Eight patients (55 ± 10 years/88% male) had a large acquired portosystemic shunt which was suitable for filter-assisted shunt embolization. Indications for the procedure: 3 = pre-transplantation optimization, 2 = overt hepatic encephalopathy (HE), 1 = post-transplant thrombosis, 1 = portal vein thrombosis and encephalopathy, 1 = encephalopathy and variceal bleeding. Portosystemic shunts occurred between splenic and renal veins, inferior mesenteric and gonadal veins, and coronary veins. Mean shunt diameter was 27 ± 5 mm. The technical success of the procedure was 8/8 (100%). In 7 patients, a transjugular intrahepatic portosystemic shunt (TIPS) was also placed at the time of the shunt embolization due to either pre-transplant indication or sluggish portal flow. There were no intraprocedural complications from filter placement.
OUTCOMES
3 = currently listed for transplant, 2 = resolution of HE, 1 = made CMO, 1 patient with patent post-transplant vasculature. 1 = died as a complication related to TIPS placement (SIR Class F Complication).
CONCLUSION
Filter-assisted shunt embolization is a technically feasible and safe technique to reduce or embolize large portosystemic shunts.
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