Transhepatic splenic vein embolization during temporary balloon occlusion of a spontaneous portosystemic shunt for chronic portosystemic encephalopathy

A 69-year-old woman undergoing medical treatment for liver cirrhosis with chronic hepatic encephalopathy developed consciousness disturbance. Emergency blood analysis revealed hyperammonemia, and abdominal CT demonstrated a large splenorenal shunt as the cause of her symptoms. The splenic vein was embolized at the portal side of the shunt entrance via the percutaneous transhepatic route, while preserving the splenorenal shunt and preventing retrograde flow to the splenorenal shunt from the superior mesenteric vein. The temporary balloon occlusion of the outflow pathway of the shunt allowed safe and accurate embolization with detachable coils under the flow control of the shunt. After the interventional procedure, her blood NH3 level decreased markedly, and the hepatic encephalopathy immediately disappeared. Postprocedural elevation of portal blood pressure was slight.