%0 Journal Article
%T Atypical use of ALN inferior vena cava filters as protection devices prior to embolization of a large portosystemic shunt with amplatzer vascular plugs and Glubran 2 cyanoacrylate glue
%A Marco Midulla
%A Marianne Latournerie
%A Nicolas Falvo
%A Olivier Chevallier
%A Pierre-Emmanuel Berthod
%A Romaric Loffroy
%A Sophie Gehin
%J SCIE-indexed Journal
%D 2018
%X Spontaneous portosystemic shunts usually develop as a result of portal hypertension caused by liver cirrhosis, and may subsequently lead to hepatic encephalopathy (1,2). In cases of severe portal hypertension, a part of the portal blood may reverse direction and pass through the portosystemic anastomoses into the systemic venous system. As a consequence, a variety of hepatofugal collateral vessels can develop. Porto-renal shunts are frequent portosystemic collateral pathways between the portal vein and the left renal vein that can lead to hepatic encephalopathy (3,4). Vascular shunt occlusion has been described in patients with spontaneous hepatic encephalopathy, in whom transjugular intrahepatic portosystemic shunt (TIPS) is contraindicated (4-9). However, embolization of these shunt vessels may be particularly difficult for two main reasons. First, when these vessels are large, >20 mm in diameter, no embolic material can be safely placed and blocked into the vessel. Second, circulation into the shunt often reverses direction and pass into the systemic venous system, leading to challenging deposit of embolic agents. The present report describes an example of atypical endovascular treatment of a large high-flow porto-renal venous shunt using ALN filters as protection devices at first, and then a combination of Amplatzer Vascular Plugs (AVP) and Glubran2 cyanoacrylate glue to totally occlude the shunt. To our knowledge, there is no mention in the literature regarding this combination of embolic materials for embolization of a portosystemic shunt affecting the left renal vein
%U http://qims.amegroups.com/article/view/19003/19646