{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T13:34:22Z","timestamp":1762522462548,"version":"3.40.5"},"reference-count":36,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,7,15]],"date-time":"2020-07-15T00:00:00Z","timestamp":1594771200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hepatology Research"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p>This study describes a case of hepatitis C virus\u2010related decompensated cirrhosis with portal\u2010systemic liver failure and refractory encephalopathy. It was successfully managed with a combination of interventional radiology and pharmacotherapy, to improve hepatic function, including hyperammonemia and to control portal\u2010splenic venous hemodynamics with hepatic venous pressure gradient (HVPG) monitoring. A man in his late 50s presented with a Child\u2013Pugh score of 13, Model for End\u2010Stage Liver Disease\u2010sodium (MELD\u2010Na) score of 19 and blood ammonia level of 185\u00a0\u03bcg\/dL. He underwent balloon\u2010occluded retrograde transvenous obliteration (BRTO) followed by partial splenic embolization (PSE) and non\u2010selective beta\u2010blocker (NSBB) administration. BRTO induced drastic changes in the portal\u2010splenic venous hemodynamics, resulting in dramatically improved hepatic function and reduced hyperammonemia. However, the procedure resulted in increased HVPG from 13.6\u00a0mmHg at baseline to 23.5\u00a0mmHg at 1\u2010month post\u2010BRTO, accompanied by ascites retention and development of portal hypertensive gastropathy. Thereafter, PSE was performed, followed by NSBB administration, to control the elevated portal venous pressure following BRTO. Postoperatively, the patient's ascites and portal hypertensive gastrophy improved after splenic artery embolization, which eventually disappeared after the additional administration of NSBBs 1\u00a0month later. The HVPG finally decreased to 16.9\u00a0mmHg; the Child\u2013Pugh score, MELD\u2010Na score and blood ammonia level improved to 7, 11 and 22\u00a0\u03bcg\/dL, respectively, after all therapies. BRTO significantly improved the symptoms of portal\u2010systemic liver failure with refractory encephalopathy. PSE and NSBB administration could contribute to additional amelioration of hepatic function and successful management of complications induced by portal hemodynamic changes following BRTO.<\/jats:p>","DOI":"10.1111\/hepr.13545","type":"journal-article","created":{"date-parts":[[2020,7,1]],"date-time":"2020-07-01T20:10:11Z","timestamp":1593634211000},"page":"1201-1208","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Significant improvement in portal\u2010systemic liver failure symptoms and successful management of portal\u2010splenic venous hemodynamics by the combination of interventional radiology and pharmacotherapy"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3722-3083","authenticated-orcid":false,"given":"Tsuyoshi","family":"Ishikawa","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Yamaguchi University Graduate School of Medicine  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