Closing spontaneous portosystemic shunts in cirrhosis: Does it make sense? Does it work? What does it take?

Wim Laleman*, Michael Praktiknjo, Mette Munk Lauridsen, Lawrence Bonne, Emma Vanderschueren, Chris Verslype, Aleksander Krag, Jonel Trebicka, Geert Maleux

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


Spontaneous portosystemic shunts (SPSS) are an often neglected cause of hepatic encephalopathy associated with cirrhosis. Nowadays, SPSS are considered as radiological biomarkers of clinically significant portal hypertension rather than the previous dogmatic perceived decompressive vessels. SPSS are not rare as they can be diagnosed in over 60% of the patients with cirrhosis by mere contrast-enhanced CT. Moreover, they are clinically relevant since they impact on all portal hypertensive related complications, in particular medically refractory HE, and represent an independent predictor of decompensation and mortality in cirrhosis, irrespective of the type of SPSS. Taken together, these elements warrant strategies to target these shunts directly which is currently is achieved via interventional radiology embolization. In this review, we discuss why it makes sense to tackle SPSS, how to do it and what it takes to do it right based on aggregated literature.

Original languageEnglish
JournalMetabolic Brain Disease
Pages (from-to)1717-1728
Publication statusPublished - Jun 2023


  • Cirrhosis
  • Embolization
  • MELD
  • Portal hypertension
  • Refractory hepatic encephalopathy
  • Spontaneous portosystemic shunt
  • Embolization, Therapeutic/adverse effects
  • Liver Cirrhosis/complications
  • Portasystemic Shunt, Transjugular Intrahepatic/adverse effects
  • Hypertension, Portal/complications
  • Humans
  • Hepatic Encephalopathy/therapy


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