Chikamori Fumio, Ito Satoshi, Hamada Ryo, Sharma Niranjan
Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan.
Department of Radiology, Japanese Red Cross Kochi Hospital, Kochi, Japan.
Radiol Case Rep. 2023 Jul 7;18(9):3274-3280. doi: 10.1016/j.radcr.2023.06.040. eCollection 2023 Sep.
We report a case of portosystemic encephalopathy treated by retrograde transvenous obliteration (RTO) with an antecubital vein approach using a steerable triaxial system. A 77-year-old female was referred to our department complaining of dizziness and tremor. Laboratory data showed hyperammonemia. Contrast-enhanced CT and 3D-CT reconstruction images demonstrated an inferior mesenteric vein (IMV)-left common iliac vein shunt and a splenorenal shunt. The former was treated as a responsible shunt. The spleen volume was 212 mL, and the liver volume was 757 mL; giving a spleen/liver volume ratio of 0.3. Partial splenic artery embolization (PSE) was employed to control portal venous pressure. The hepatic venous pressure gradient (HVPG) changed from 13.2 to 9.6 mm Hg and the spleen/liver volume ratio improved from 0.3 to 0.2 by PSE. Two months after PSE, RTO with an antecubital vein approach using a steerable triaxial system was performed. HVPG changed to 12.5 mm Hg after RTO. Contrast-enhanced CT and 3D-CT reconstruction images 3 days after the procedure demonstrated the thrombus in the IMV-left common iliac vein shunt. We conclude that the antecubital vein approach using a steerable triaxial system is a feasible and minimally invasive technique in RTO for portosystemic shunts.
我们报告了一例采用可操控三轴系统经肘前静脉逆行静脉闭塞术（RTO）治疗的门体分流性脑病病例。一名77岁女性因头晕和震颤转诊至我科。实验室检查显示高氨血症。增强CT和三维CT重建图像显示肠系膜下静脉（IMV）-左髂总静脉分流及脾肾分流。前者被视为责任分流。脾脏体积为212 mL，肝脏体积为757 mL；脾/肝体积比为0.3。采用部分脾动脉栓塞术（PSE）控制门静脉压力。PSE后肝静脉压力梯度（HVPG）从13.2降至9.6 mmHg，脾/肝体积比从0.3改善至0.2。PSE两个月后，采用可操控三轴系统经肘前静脉进行RTO。RTO后HVPG变为12.5 mmHg。术后3天的增强CT和三维CT重建图像显示IMV-左髂总静脉分流处有血栓形成。我们得出结论，采用可操控三轴系统经肘前静脉进行RTO是一种治疗门体分流的可行且微创的技术。
