Your browser doesn't support javascript.
loading
Coil-Assisted Retrograde Transvenous Obliteration (CARTO): An Alternative Treatment Option for Refractory Hepatic Encephalopathy.
Lee, Edward Wolfgang; Saab, Sammy; Kaldas, Fady; Fletcher, Savannah; Busuttil, Ronald W; Durazo, Francisco; McWilliams, Justin P; DiNorcia, Joseph; Padia, Siddharth A; Kee, Stephen T.
Afiliação
  • Lee EW; Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. UCLA Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA. Division of Hepatology, Department of Medicine, University o
  • Saab S; Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. UCLA Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA. Division of Hepatology, Department of Medicine, University o
  • Kaldas F; Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. UCLA Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA. Division of Hepatology, Department of Medicine, University o
  • Fletcher S; Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. UCLA Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA. Division of Hepatology, Department of Medicine, University o
  • Busuttil RW; Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. UCLA Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA. Division of Hepatology, Department of Medicine, University o
  • Durazo F; Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. UCLA Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA. Division of Hepatology, Department of Medicine, University o
  • McWilliams JP; Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. UCLA Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA. Division of Hepatology, Department of Medicine, University o
  • DiNorcia J; Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. UCLA Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA. Division of Hepatology, Department of Medicine, University o
  • Padia SA; Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. UCLA Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA. Division of Hepatology, Department of Medicine, University o
  • Kee ST; Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. UCLA Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA, USA. Division of Hepatology, Department of Medicine, University o
Am J Gastroenterol ; 113(8): 1187-1196, 2018 08.
Article em En | MEDLINE | ID: mdl-29899437
ABSTRACT

BACKGROUND:

Overt hepatic encephalopathy (OHE) is a serious complication of liver dysfunction, which is associated with severe morbidity/mortality and healthcare resource utilization. OHE can be medically refractory due to spontaneous portosystemic shunts (SPSSs) and therefore a new treatment option for these SPSSs is critical.

METHODS:

This is a retrospective study of 43 patients with medically refractory OHE, who underwent CARTO (Coil-Assisted Retrograde Transvenous Obliteration) procedures between June 2012 and October 2016. The patient demographic characteristics, technical and clinical outcomes with an emphasis on HE improvement, and complications are reviewed and analyzed.

RESULTS:

The overall clinical success rate was 91% with a significant HE improvement. Eighty-one percent of patients had clinically significant improvement from OHE and 67% of patients had complete resolution of their HE symptoms during our follow-up period of 893 ± 585 days (range 36-1881 days, median 755.0 days). The median WH score improved from 3 (range 2-4) pre-CARTO to 1 (range 0-4) post-CARTO (p < 0.001). The median ammonia level significantly decreased from 134.5 pre-CARTO to 70.0 post-CARTO (p < 0.001) in 3 days. The overall mean survival was 1465.5 days (95% CI of 1243.0 and 1688.0 days). Only three patients had recurrent HE symptoms. There were 39.6% minor complication rate including new or worsened ascites and esophageal varices, and only 2.3% major complication rate requiring additional treatment (one patient with bleeding esophageal varices requiring treatment). No procedure-related death is noted.

CONCLUSIONS:

CARTO appears to be a safe and effective treatment option for refractory overt hepatic encephalopathy (OHE) due to spontaneous portosystemic shunts. CARTO could be an excellent addition to currently available treatment options for these patients.
Assuntos
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Encefalopatia Hepática / Embolização Terapêutica Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Ano de publicação: 2018 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Encefalopatia Hepática / Embolização Terapêutica Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Ano de publicação: 2018 Tipo de documento: Article