Simultaneous portosystemic shunt and proximal splenic artery embolization for patients with therapy-refractory hepatic encephalopathy at risk of portal hypertensive complications

This case highlights the potential of combining SPSS closure and pSAE, two procedures that have not been combined before to our knowledge, to effectively reduce HE and HVPG, enabling cessation of anti-encephalopathic therapy and lowering paracentesis frequency. However, altered vascular anatomy can lead to complications such as splenic infarction. Although splenic infarction occurred as a complication, we believe this novel combined procedure warrants further investigation.