Closing spontaneous portosystemic shunts in cirrhosis: Does it make sense? Does it work? What does it take?
Wim LalemanMichael PraktiknjoMette Munk Enok LauridsenLawrence BonneEmma VanderschuerenChris VerslypeAleksander KragJonel TrebickaGeert MaleuxPublished in: Metabolic brain disease (2022)
Spontaneous portosystemic shunts (SPSS) are an often neglected cause of hepatic encephalopathy associated with cirrhosis. Nowadays, SPSS are considered as radiological biomarkers of clinically significant portal hypertension rather than the previous dogmatic perceived decompressive vessels. SPSS are not rare as they can be diagnosed in over 60% of the patients with cirrhosis by mere contrast-enhanced CT. Moreover, they are clinically relevant since they impact on all portal hypertensive related complications, in particular medically refractory HE, and represent an independent predictor of decompensation and mortality in cirrhosis, irrespective of the type of SPSS. Taken together, these elements warrant strategies to target these shunts directly which is currently is achieved via interventional radiology embolization. In this review, we discuss why it makes sense to tackle SPSS, how to do it and what it takes to do it right based on aggregated literature.
Keyphrases
- contrast enhanced
- magnetic resonance imaging
- computed tomography
- blood pressure
- diffusion weighted
- magnetic resonance
- systematic review
- risk factors
- physical activity
- depressive symptoms
- dual energy
- artificial intelligence
- mental health
- cardiovascular events
- early onset
- social support
- image quality
- cardiovascular disease
- traumatic brain injury
- positron emission tomography
- deep learning
- arterial hypertension