Effects of restoring portal flow with anticoagulation and partial splenorenal shunt embolization.

S pontaneous portosystemic shunt (PSS) from portal hypertension is associated with portal vein (PV) stasis and chronic hepatic encephalopathy (HE). Embolization of PSS is effective in select cases of refractory HE, but is relatively contraindicated in patients with portal vein thrombosis (PVT) (Table 1). This procedure redirects significant blood flow back through the PV and has been reported to improve liver function. We present a case of a new PVT in a cirrhosis patient with refractory HE thought secondary to PSS. This was treated sequentially with 6 months anticoagulation to achieve PV patency, followed by partial coil embolization of a large PSS. One year later, imaging revealed a 54% increase in liver volume.