Simultaneous use of plug-assisted and coil-assisted retrograde transvenous obliteration for treating refractory hepatic encephalopathy in a patient with two portosystemic shunts: A case report

Plug-assisted retrograde transvenous obliteration (PARTO) or coil-assisted retrograde transvenous obliteration (CARTO) are alternative treatments for gastric variceal bleeding and hepatic encephalopathy. Both procedures have fewer complications related to balloon rupture or sclerosing agents and are shorter than balloon-occluded retrograde transvenous obliteration. Herein, we report a case of PARTO and CARTO was performed simultaneously to treat refractory hepatic encephalopathy in a patient with 2 portosystemic shunts. PATIENT CONCERNS: A 59-year-old man with alcoholic liver cirrhosis presented to the emergency room with mental change. At presentation, the patient’s plasma ammonia level was 340 μg/dL. DIAGNOSES: A computed tomography scan revealed perisplenic collateral vessels and 2 splenorenal shunts. INTERVENTION: PARTO and CARTO were performed to treat hepatic encephalopathy via the 2 splenorenal shunts. OUTCOMES: A follow-up computed tomography scan showed the splenorenal shunt was successfully embolized using a vascular plug and coil. After 3 weeks, the patient’s plasma ammonia level decreased to 80 μg/dL, and repeated hospitalizations due to hepatic encephalopathy ceased. LESSONS: Depending on the patient’s anatomy, PARTO and CARTO can be performed simultaneously and, similar to balloon-occluded retrograde transvenous obliteration, are useful for treating hepatic encephalopathy.