Amar Mukund, Presenter: Nothing to Disclose

S. Rajesh MBBS, MD, Abstract Co-Author: Nothing to Disclose

Ankur Arora MD, FRCR, Abstract Co-Author: Nothing to Disclose

Shiv Sarin, Abstract Co-Author: Nothing to Disclose

To evaluate the efficacy of BRTO using foam sclerotherapy in managing symptoms arising due to spontaneous large porto-systemic shunts.

20 sessions of BRTO was performed in 18 patients using sodium tetradecyl sulphate foam. All patients had cirrhosis along with history of recurrent hepatic encephalopathy requiring hospital admission. Porto-systemic communication in the form of gastro/lieno-renal shunt was present in all cases and seen on pre procedure computed tomography scans. Clinical and lab parameters including arterial ammonia level were evaluated before and after the procedure in all patients.

Technical success was achieved in 18 of 20 sessions (90%). Complete obliteration of varices was seen in 15 of 18 patients (83%) and partial obliteration in remaining 3, on follow up imaging. Immediate clinical improvement of hepatic encephalopathy was observed in 16 of 18 patients (89%) with post procedure decrease in serum ammonia levels, two patients had delayed improvement. Post-procedure complication consisting either of ascites, septicemia with acute kidney injury or deranged liver function tests was encountered in 5 patients. All the patients were clinically and symptomatically better on discharge and up to a follow up of 18 months (one month and thereafter 3, 6, 12, 18 months).

Our experience suggests portal systemic hepatic encephalopathy refractory to medical management can be effectively treated by BRTO.

This study shows that BRTO may be offered as an alternative treatment to patients having recurrent portal systemic encephalopathy refractory to medical management.

Mukund, A, Rajesh, S, Arora, A, Sarin, S, Treating Portal Systemic Encephalopathy with Balloon-occluded Retrograde Transvenous Obliteration (BRTO) – A Road Less Travelled.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13018449.html