PMC3134060_01
MD-CT revealed a porto-systemic shunt from the inferior mesenteric vein (IMV) draining to the inferior vena cava (IVC) with narrowed portal trunk (a). The draining blood flow of the IMV-IVC shunt was blocked by inflating the balloon, and 15 ml of 5% ethanolamine oleate with iopamidol was injected slowly in a retrograde manner (b).
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F1
Multi detector-row computed tomography (MD-CT) and three-dimensional angiography by MD-CT revealed a porto-systemic shunt from the inferior mesenteric vein (IMV) draining to the inferior vena cava (IVC) (fig. 1a). Tokyo, Japan) was introduced into the IMV-IVC shunt via the right transjugular vein and the shunt was visualized using iopamidol. The IMV-IVC shunt was confirmed to be the only route, and the draining blood flow was blocked by inflating the balloon. 40 ml of 50% glucose and 2 ml of absolute ethanol were injected, and 15 ml of 5% ethanolamine oleate with iopamidol was injected slowly in a retrograde manner (fig. 1b).
The serum ammonia level decreased immediately after B-RTO (a). Serum total bilirubin level decreased and albumin level increased after the treatment (b, c). These results were sustained over a 5-month follow-up.
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F2
The clinical symptoms of hepatic encephalopathy completely disappeared (stage 0 by West Haven criteria) 2 weeks after the treatment, and the serum ammonia level decreased immediately (fig. 2a). Serum total bilirubin decreased and albumin increased after the treatment (fig. 2b, c).
Contrast-enhanced CT scans performed 2 weeks after the B-RTO revealed that the narrowed portal trunk and the left branch were expanded (a, b), accompanied by embolization of the IMV-IVC shunt (c).
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F3
IMV-IVC shunt (fig. 3c). In addition, the edema in both lower extremities and ascites disappeared after treatment.