Restoration of portal venous perfusion and reversal of encephalopathy by balloon occlusion of portal systemic shunt.

Operative ligation of total portasystemic shunts is effective in reversing hepatic encephalopathy but is associated with significant mortality. In the case reported, invasive radiographic techniques were used to occlude a mesorenal shunt and reverse recurrent, disabling encephalopathy in a 72-yr-old woman. Occlusion of the shunt, coupled with coronary vein embolization, improved angiographic portal perfusion from grade IV to grade I, increased nutrient liver blood flow from 577 ml/min to 848 ml/min, and increased the hepatic fraction of cardiac output from 8.8% to 24.9%. Improved hepatocyte function was measured by an increase in galactose elimination capacity from 123 mg/min to 166 mg/min and a decrease in fasting ammonia from 107 micrograms/dl to 33 micrograms/dl. A 10-mo follow-up showed that there has been no recurrence of encephalopathy or variceal hemorrhage. Based on this experience, we conclude that (a) in selected cases total portasystemic shunts can be occluded by invasive radiographic techniques, and (b) restoration of portal perfusion can reverse hepatic encephalopathy and improve liver function.