13th Annual Global Embolization Symposium & Technologies
Purpose : Hepatopulmonary syndrome occurs in patients with chronic liver disease as a result of excessive production of vasodilators leading to arteriovenous shunting and profound hypoxia. We present a young male with liver cirrhosis who was planned for elective liver transplant before he started to deteriorate due to hepatopulmonary syndrome and severe hypoxia that required prolonged intubation. CT scan of the chest showed bilateral peripheral type 2 pulmonary arteriovenous shunts. The pulmonary shunts were successfully embolized with coils and vascular plugs. The patient clinical condition improved and was extubated on the next day.
Material and Methods : The right femoral vein was punctured utilizing a 19G needle, followed by insertion of short vascular sheath. Catheter and guide-wire were advanced to the atriocaval junction. The short vascular sheath was removed and replaced with long 45 vascular sheath (Destination). H1H catheter was successfully advanced into the pulmonary artery over the guide-wire. Catheter then was replaced with pigtail catheter. Pulmonary Angiogram was performed for both lungs which shows bilateral lower lobe arteriovenous shunting, more at the right side.
The vascular sheath was successfully advanced into the main pulmonary artery.
Bilateral pulmonary arteriovenous shunt embolization was performed utilizing microvascular plug (size 5.3 mm and 6.5 mm), Amplatzer VP4 (8 mm, 4 mm, and 6 mm), and interlock coils (size 4 mm, 3 mm, and 6 mm). Post-embolization angiogram was performed through the pigtail catheter which shows successful embolization of the large arteriovenous shunting. The vascular sheath and catheter were removed and hemostasis was achieved with manual compression.
Results : The large bilateral lower lobe arteriovenous shunting were successfully embolized. The patient's oxygen saturation improved throughout the procedure. The patient was successfully extubated in the next day with oxygen saturation around 90% in room air.
Conclusions : Hepatopulmonary syndrome is a serious clinical condition that result in sever hypoxia due to pulmonary arteriovenous shunting. Embolization of these shunts can help to improve the patient clinical condition and bridge the patient for future elective liver transplant.