Table 3.
Efficacy and safety in SPSS embolization. Main results from recent studies that evaluate efficacy and safety of embolization.
| Reference | n | SPSS | Embolization (access, material and technique) | Efficacy/Safety |
|---|---|---|---|---|
| Laleman et al.68 | 37 | Splenorenal: 20 Paraumbilical: 9 Mesocaval: 7 Mesorenal: 1 |
Percutaneous (paraumbilical); transhepatic (the others) Material: coils (59%), Amplatzer plugs (35%), matrix or a combination |
% free of HE: - Short-term (100 days): 59.4%* - Long-term (2 years): 48.6%*- Procedure-related complications: 7 mild/1 capsular bleeding - Long-term: De novo EV: 2 (1 small, 1 large) GEV: no significant increase EV bleeding: 1 nonfatal at 55 months Ascites: no significant differences PVT: 4 (11%; 1 in PV, 3 in one branch) |
| Lynn et al.87 | 20 | Splenorenal: 12 | Transhepatic (25%), also right femoral, internal jugular, paraumbilical, right axillary. Material: coils (75%), Amplatzer plugs (20%) or combination |
% HE with sustained improvement - Short-term (1–4 months): 100%** - Long-term (6–12 months): 92%**- Procedure-related complications: 10% 1 mild/1 bacterial cholangitis - Long-term (12 months): De novo EV: 1 (small) Ascites (new or worsening): 6 (4 paracentesis) |
| An et al.88 | 17 | Splenorenal: 14 Paraumbilical: 3 | Percutaneous (paraumbilical); femoral (splenorenal) Material: Amplatzer plugs, coils combined with gelatin sponges |
Recurrence of OHE for 2 years: 39.9% (embolized) versus 79.9% (control)*- No serious procedure-related complications - Long-term: MELD ⩽ 15 and no HCC Ascites: mild 3 (18%) EV (small-sized new or worsened): 3 (18%) No GIB No PVT |
| Naeshiro et al.89 | 14 | Splenorenal: 3 Gastrorenal: 4 Mesocaval: 5 Portocaval: 2 |
Percutaneous Material: EOI, coils and NBCA (B-RTO or CARTO) |
HE disappearance in 1–2 weeks: 93%- No serious procedure-related complications - Long-term: EV: worsening at 3 months (21%) EV: worsening at 24 months (29%) GIB: 14% |
| Inoue et al.90 | 19 | Splenorenal: 19 | EOI, coil and NBCA (B-RTO) |
HE improvement: 100%*- No serious procedure-related complications - Long term: ascites: 21% |
| Philips et al.91 | 21 | Splenorenal: 17 Mesocaval: 7 plus others |
Transjugular (71%), transhepatic (19%), transfemoral (4.8%) CARTO, PARTO, B-RTO or a combination |
HE improvement: - Short-term follow up: 71%* - Long-term: 23%Serious procedure-related complications: 1 hemoperitoneum with multiple organ failure - Long-term: EV: No significant increase GIB: 1 nonfatal, controlled with band ligation (122 days post-occlusion). Ascites: no significant increase |
B-RTO, balloon-occluded retrograde transvenous obliteration; CARTO, coil-assisted retrograde transvenous obliteration; EOI, ethanolamine oleate with iopaminol; EV, esophageal varices; GEV, gastroesophageal varices; GIB, gastrointestinal bleeding; HE, hepatic encephalopathy; HCC, hepatocellular carcinoma; NBCA, N-butyl cyanoacrylate; MELD, Model for End-stage Liver Disease; OHE, Overt hepatic encephalopathy; PARTO, vascular plug-assisted transvenous obliteration; PVT, portal vein thrombosis; SPSS, spontaneous portosystemic shunt.
*
p < 0.05. **Per-protocol analysis.