Arterio-portal shunt in liver rescued by hepatectomy after arterial embolization

S. Kobayashi, T. Asano, Takashi Kenmochi, K. Saigo, S. Matsutani, H. Maruyama, H. Saisho, K. Okuda, T. Ochiai

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Arterio-portal shunts are generally treated with transcatheter arterial embolization, as a therapeutic measure for bleeding of esophageal varices. However, transcatheter arterial embolization is frequently associated with reestablishment of arterio-portal shunts. We now report our experience with partial hepatectomy to remove the arterio-portal shunt associated with esophageal varices, which recurred after transcatheter arterial embolization. The patient was a 60-year-old female, who had massive hematemesis caused by rupture of esophageal varices. Doppler sonography and arteriography demonstrated an arterio-portal shunt in the right anterior superior segment of the liver. Temporary hemostasis was achieved with transcatheter arterial embolization, however, hemorrhage recurred one month later. The second transcatheter arterial embolization failed to manage the shunt and varices. The patient developed hepatic coma. After recovery from coma, she was referred to our hospital. We carried out partial hepatectomy, which provided remarkable hemodynamic improvement; the portal vein flow changed from hepatofugal to hepatopetal. Esophageal varices and hepatic coma have totally disappeared. This patient has had no complaint and has remained free of esophageal varices, for 3 years postoperatively. She is having a normal life. The partial hepatectomy to remove the arterio-portal shunt induced complete resolution of the arterio-portal shunt, as well as dramatic improvement in portal flow and hepatic coma. Our experience in the present case suggests that partial hepatectomy should be considered as a radical therapy for arterio-portal shunt, without insistence on transcatheter arterial embolization.

Original languageEnglish
Pages (from-to)1730-1732
Number of pages3
JournalHepato-Gastroenterology
Volume48
Issue number42
Publication statusPublished - 01-12-2001

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Esophageal and Gastric Varices
Hepatectomy
Hepatic Encephalopathy
Liver
Hemorrhage
Hematemesis
Doppler Ultrasonography
Varicose Veins
Coma
Portal Vein
Hemostasis
Rupture
Angiography
Hemodynamics
Therapeutics

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Kobayashi, S., Asano, T., Kenmochi, T., Saigo, K., Matsutani, S., Maruyama, H., ... Ochiai, T. (2001). Arterio-portal shunt in liver rescued by hepatectomy after arterial embolization. Hepato-Gastroenterology, 48(42), 1730-1732.
Kobayashi, S. ; Asano, T. ; Kenmochi, Takashi ; Saigo, K. ; Matsutani, S. ; Maruyama, H. ; Saisho, H. ; Okuda, K. ; Ochiai, T. / Arterio-portal shunt in liver rescued by hepatectomy after arterial embolization. In: Hepato-Gastroenterology. 2001 ; Vol. 48, No. 42. pp. 1730-1732.
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Kobayashi, S, Asano, T, Kenmochi, T, Saigo, K, Matsutani, S, Maruyama, H, Saisho, H, Okuda, K & Ochiai, T 2001, 'Arterio-portal shunt in liver rescued by hepatectomy after arterial embolization', Hepato-Gastroenterology, vol. 48, no. 42, pp. 1730-1732.

Arterio-portal shunt in liver rescued by hepatectomy after arterial embolization. / Kobayashi, S.; Asano, T.; Kenmochi, Takashi; Saigo, K.; Matsutani, S.; Maruyama, H.; Saisho, H.; Okuda, K.; Ochiai, T.

In: Hepato-Gastroenterology, Vol. 48, No. 42, 01.12.2001, p. 1730-1732.

Research output: Contribution to journalArticle

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T1 - Arterio-portal shunt in liver rescued by hepatectomy after arterial embolization

AU - Kobayashi, S.

AU - Asano, T.

AU - Kenmochi, Takashi

AU - Saigo, K.

AU - Matsutani, S.

AU - Maruyama, H.

AU - Saisho, H.

AU - Okuda, K.

AU - Ochiai, T.

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N2 - Arterio-portal shunts are generally treated with transcatheter arterial embolization, as a therapeutic measure for bleeding of esophageal varices. However, transcatheter arterial embolization is frequently associated with reestablishment of arterio-portal shunts. We now report our experience with partial hepatectomy to remove the arterio-portal shunt associated with esophageal varices, which recurred after transcatheter arterial embolization. The patient was a 60-year-old female, who had massive hematemesis caused by rupture of esophageal varices. Doppler sonography and arteriography demonstrated an arterio-portal shunt in the right anterior superior segment of the liver. Temporary hemostasis was achieved with transcatheter arterial embolization, however, hemorrhage recurred one month later. The second transcatheter arterial embolization failed to manage the shunt and varices. The patient developed hepatic coma. After recovery from coma, she was referred to our hospital. We carried out partial hepatectomy, which provided remarkable hemodynamic improvement; the portal vein flow changed from hepatofugal to hepatopetal. Esophageal varices and hepatic coma have totally disappeared. This patient has had no complaint and has remained free of esophageal varices, for 3 years postoperatively. She is having a normal life. The partial hepatectomy to remove the arterio-portal shunt induced complete resolution of the arterio-portal shunt, as well as dramatic improvement in portal flow and hepatic coma. Our experience in the present case suggests that partial hepatectomy should be considered as a radical therapy for arterio-portal shunt, without insistence on transcatheter arterial embolization.

AB - Arterio-portal shunts are generally treated with transcatheter arterial embolization, as a therapeutic measure for bleeding of esophageal varices. However, transcatheter arterial embolization is frequently associated with reestablishment of arterio-portal shunts. We now report our experience with partial hepatectomy to remove the arterio-portal shunt associated with esophageal varices, which recurred after transcatheter arterial embolization. The patient was a 60-year-old female, who had massive hematemesis caused by rupture of esophageal varices. Doppler sonography and arteriography demonstrated an arterio-portal shunt in the right anterior superior segment of the liver. Temporary hemostasis was achieved with transcatheter arterial embolization, however, hemorrhage recurred one month later. The second transcatheter arterial embolization failed to manage the shunt and varices. The patient developed hepatic coma. After recovery from coma, she was referred to our hospital. We carried out partial hepatectomy, which provided remarkable hemodynamic improvement; the portal vein flow changed from hepatofugal to hepatopetal. Esophageal varices and hepatic coma have totally disappeared. This patient has had no complaint and has remained free of esophageal varices, for 3 years postoperatively. She is having a normal life. The partial hepatectomy to remove the arterio-portal shunt induced complete resolution of the arterio-portal shunt, as well as dramatic improvement in portal flow and hepatic coma. Our experience in the present case suggests that partial hepatectomy should be considered as a radical therapy for arterio-portal shunt, without insistence on transcatheter arterial embolization.

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Kobayashi S, Asano T, Kenmochi T, Saigo K, Matsutani S, Maruyama H et al. Arterio-portal shunt in liver rescued by hepatectomy after arterial embolization. Hepato-Gastroenterology. 2001 Dec 1;48(42):1730-1732.