The Outcome of Portosystemic Shunt Obliteration in the Management of Hepatic Encephalopathy

Sunday, March 30, 2025

4:12 PM – 4:21 PM CT

Location: Music City Center, 202 A

Presenting Author(s)

Lucas F. Sheridan, DO (he/him/his)

Radiology Resident
University of South Alabama, United States

Author/Co-author(s)

ZH

Zeiad Hussain, MD

Attending physician, Interventional Radiology
University of South Alabama, United States
Charles R. Diard, MD (he/him/his)

Radiology Resident
University of South Alabama, United States
OA

Osama Abdul-Rahim, MD

Interventional Radiologist
Stride Healthcare, United States
PH

Phillip Henderson, DO

Gastroenterologist, Associate Professor, Medical Director of Transplantation
University of South Alabama, United States
AS

Anas Souid, MD

Radiology Resident
University of South Alabama, United States

Purpose: Hepatic encephalopathy (HE), a complication of liver cirrhosis and portal hypertension, impairs cognitive and motor functions. In cases where medical treatments fail or are intolerable, alternative approaches are needed. Portosystemic shunt (PSS) embolization, including balloon-occluded, plug-assisted, and coil-assisted retrograde transvenous obliteration (BRTO, PARTO, CARTO), offers a viable second-line treatment. We present our 5-year institutional experience with PSS embolization for refractory HE.

Materials and Methods: Retrospective review of prospectively maintained clinical, procedural, and demographic data from patients underwent portosystemic shunt (PSS) obliteration for refractory hepatic encephalopathy (HE) between November 2016 and July 2023. Technical success was defined by complete occlusion of the PSS, confirmed by immediate procedural outcomes and cross-sectional imaging. Clinical success was based on HE symptom improvement. The primary outcome was improvement in HE symptoms including patient-graded outcome, West Haven Grade (WHG), and ECOG , while changes in liver function tests were secondary outcomes.

Results: Fifty-two patients (mean age 57 years, 23 male) with refractory hepatic encephalopathy (HE) underwent PSS obliteration between May 2017-July 2023. On short-term follow-up (median 1.18 months), 37 of 52 (71%) patients reported marked improvement in HE symptoms, with 32 experiencing no recurrence on long-term follow-up (median 32.1 months). A significant mean reduction in WHG by 1.06 (95% CI [0.83, 1.28]) and an improvement in ECOG performance status by 0.74 (95% CI [0.51, 0.96]) were observed short-term. Long-term ECOG performance status also showed a significant improvement of 0.56 (95% CI [0.26, 0.85]). A significant mean reduction in short-term Child-Pugh score by 0.69 (95% CI [0.43, 0.95]) and a non-significant trend toward improvement in MELD score was noted (mean 0.52, 95% CI [-0.17, 1.21]). Complications included portal vein thrombosis (n=3), hydrothorax (n=1), variceal enlargement (n=2), ascites (n=3), severe pain (n=1), bleeding (n=2), and one mortality.

Conclusion: PSS embolization significantly improves hepatic encephalopathy symptoms, performance status, and functional outcomes when medical therapy fails. Trends toward enhanced liver function (MELD criteria) were observed. Close follow-up is critical to monitor complications like portal hypertension, ascites, and variceal development. Further research is needed to confirm outcomes and refine patient selection criteria for optimal treatment success.