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Paradoxical cerebral emboli after transjugular intrahepatic portosystemic shunt and coil embolization for treatment of duodenal varices.
Am J Gastroenterol. 1997 Aug; 92(8):1372-3.AJ

Abstract

The use of the transjugular intrahepatic portosystemic shunt to treat portal hypertension has resulted in increased recognition of its associated complications. We report a patient with refractory duodenal variceal bleeding treated with transjugular intrahepatic portosystemic shunt, as well as coil embolization, who subsequently developed bilateral cerebral and cerebellar infarcts consistent with arterial emboli. This complication has not been previously described. The patient was found to have a patent foramen ovale and a right to left intracardiac shunt leading to paradoxical embolization of clots traveling from portal to systemic venous circulation, then to the left atrium. With the relative frequency of patent foramen ovale in the population, our observation has potential importance for patients with right to left cardiac shunts who are being considered for portosystemic shunt procedures, or who are undergoing embolization of bleeding varices.

Authors+Show Affiliations

Department of Medicine, University of Washington Medical Center, Seattle 98195, USA.No affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

9260811

Citation

Ponec, R J., and K V. Kowdley. "Paradoxical Cerebral Emboli After Transjugular Intrahepatic Portosystemic Shunt and Coil Embolization for Treatment of Duodenal Varices." The American Journal of Gastroenterology, vol. 92, no. 8, 1997, pp. 1372-3.
Ponec RJ, Kowdley KV. Paradoxical cerebral emboli after transjugular intrahepatic portosystemic shunt and coil embolization for treatment of duodenal varices. Am J Gastroenterol. 1997;92(8):1372-3.
Ponec, R. J., & Kowdley, K. V. (1997). Paradoxical cerebral emboli after transjugular intrahepatic portosystemic shunt and coil embolization for treatment of duodenal varices. The American Journal of Gastroenterology, 92(8), 1372-3.
Ponec RJ, Kowdley KV. Paradoxical Cerebral Emboli After Transjugular Intrahepatic Portosystemic Shunt and Coil Embolization for Treatment of Duodenal Varices. Am J Gastroenterol. 1997;92(8):1372-3. PubMed PMID: 9260811.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Paradoxical cerebral emboli after transjugular intrahepatic portosystemic shunt and coil embolization for treatment of duodenal varices. AU - Ponec,R J, AU - Kowdley,K V, PY - 1997/8/1/pubmed PY - 1997/8/1/medline PY - 1997/8/1/entrez SP - 1372 EP - 3 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 92 IS - 8 N2 - The use of the transjugular intrahepatic portosystemic shunt to treat portal hypertension has resulted in increased recognition of its associated complications. We report a patient with refractory duodenal variceal bleeding treated with transjugular intrahepatic portosystemic shunt, as well as coil embolization, who subsequently developed bilateral cerebral and cerebellar infarcts consistent with arterial emboli. This complication has not been previously described. The patient was found to have a patent foramen ovale and a right to left intracardiac shunt leading to paradoxical embolization of clots traveling from portal to systemic venous circulation, then to the left atrium. With the relative frequency of patent foramen ovale in the population, our observation has potential importance for patients with right to left cardiac shunts who are being considered for portosystemic shunt procedures, or who are undergoing embolization of bleeding varices. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/9260811/Paradoxical_cerebral_emboli_after_transjugular_intrahepatic_portosystemic_shunt_and_coil_embolization_for_treatment_of_duodenal_varices_ L2 - https://medlineplus.gov/varicoseveins.html DB - PRIME DP - Unbound Medicine ER -