Title |
Proximal total splenic artery embolization for refractory hepatic encephalopathy
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Published in |
Clinical Journal of Gastroenterology, December 2017
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DOI | 10.1007/s12328-017-0805-5 |
Pubmed ID | |
Authors |
Harufumi Maki, Junichi Kaneko, Junichi Arita, Nobuhisa Akamatsu, Yoshihiro Sakamoto, Kiyoshi Hasegawa, Sumihito Tamura, Hidemasa Takao, Eisuke Shibata, Norihiro Kokudo |
Abstract |
A Japanese woman with a history of Kasai operation for biliary atresia had living-donor liver transplantation at the age of 22. The first episode of refractory HE and late cellular rejection was treated by a high dose of methylprednisolone. The second episode of refractory HE was treated by balloon-occluded retrograde transvenous obliteration for a spleno-renal shunt. However, the third episode of refractory HE occurred 11 years after liver transplantation. The liver cirrhosis and hypersplenism were present with a Child-Pugh score of C-10. Although portal vein flow was hepatopetal, superior mesenteric vein flow regurgitated. We performed proximal total splenic artery embolization (TSAE). Superior mesenteric vein flow changed to a hepatopetal direction and she became clear. At a year after proximal TSAE, her spleen volume had decreased to 589 mL (20% decrease) on computed tomography. She is well and has a Child-Pugh score of 8 without overt HE. We report the first case of refractory HE treated by proximal TSAE that is a possible less invasive treatment option for a selected patient. |
X Demographics
Geographical breakdown
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India | 1 | 100% |
Demographic breakdown
Type | Count | As % |
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Members of the public | 1 | 100% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Unknown | 12 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
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Student > Postgraduate | 3 | 25% |
Student > Ph. D. Student | 2 | 17% |
Student > Master | 2 | 17% |
Professor | 1 | 8% |
Student > Bachelor | 1 | 8% |
Other | 0 | 0% |
Unknown | 3 | 25% |
Readers by discipline | Count | As % |
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Medicine and Dentistry | 6 | 50% |
Agricultural and Biological Sciences | 1 | 8% |
Veterinary Science and Veterinary Medicine | 1 | 8% |
Unknown | 4 | 33% |