Hatsuda Naotoshi, Onishi Yasuyuki, Shimizu Hironori, Nakano Mika, Takeda Haruhiko, Maki Takakuni, Nakamoto Yuji
Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Japan.
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan.
Interv Radiol (Higashimatsuyama). 2025 Jun 30;10:e20240047. doi: 10.22575/interventionalradiology.2024-0047. eCollection 2025.
An 89-year-old woman presented with altered mental status. Computed tomography revealed multiple shunts between the portal (segment 3) and hepatic veins (left and middle hepatic veins); detailed vascular anatomy of the shunts could not be determined owing to its complexity. Blood tests revealed an elevated ammonia level. The patient was diagnosed with hepatic encephalopathy secondary to an intrahepatic portosystemic venous shunt. Transcatheter embolization was performed after unsuccessful conservative treatment. The peripheral left and middle hepatic veins downstream of the shunt vessels were embolized through an internal jugular vein approach using Amplatzer vascular plugs and coils. Computed tomography conducted 1 week later indicated occlusion of the shunts. The patient's ammonia levels were normalized. Thus, transcatheter embolization can be useful for treating complex intrahepatic portosystemic venous shunts causing hepatic encephalopathy.
一名89岁女性因精神状态改变前来就诊。计算机断层扫描显示门静脉（第3段）与肝静脉（肝左静脉和肝中静脉）之间存在多处分流；由于分流情况复杂，无法确定其详细的血管解剖结构。血液检查显示氨水平升高。该患者被诊断为继发于肝内门体静脉分流的肝性脑病。在保守治疗失败后进行了经导管栓塞术。通过颈内静脉途径，使用Amplatzer血管封堵器和弹簧圈对分流血管下游的肝左静脉和肝中静脉外周进行了栓塞。1周后进行的计算机断层扫描显示分流已闭塞。患者的氨水平恢复正常。因此，经导管栓塞术可用于治疗导致肝性脑病的复杂肝内门体静脉分流。
