• Seong Gyeong Ju, Jae Myeong Lee, and Jongjoon Shim.
• Department of Radiology, University of Soonchunhyang College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon-si, Gyeonggi-do, Korea.
• Medicine (Baltimore). 2023 Jun 2; 102 (22): e33961e33961.

RationalePlug-assisted retrograde transvenous obliteration (PARTO) or coil-assisted retrograde transvenous obliteration (CARTO) are alternative treatments for gastric variceal bleeding and hepatic encephalopathy. Both procedures have fewer complications related to balloon rupture or sclerosing agents and are shorter than balloon-occluded retrograde transvenous obliteration. Herein, we report a case of PARTO and CARTO was performed simultaneously to treat refractory hepatic encephalopathy in a patient with 2 portosystemic shunts.Patient ConcernsA 59-year-old man with alcoholic liver cirrhosis presented to the emergency room with mental change. At presentation, the patient's plasma ammonia level was 340 μg/dL.DiagnosesA computed tomography scan revealed perisplenic collateral vessels and 2 splenorenal shunts.InterventionPARTO and CARTO were performed to treat hepatic encephalopathy via the 2 splenorenal shunts.OutcomesA follow-up computed tomography scan showed the splenorenal shunt was successfully embolized using a vascular plug and coil. After 3 weeks, the patient's plasma ammonia level decreased to 80 μg/dL, and repeated hospitalizations due to hepatic encephalopathy ceased.LessonsDepending on the patient's anatomy, PARTO and CARTO can be performed simultaneously and, similar to balloon-occluded retrograde transvenous obliteration, are useful for treating hepatic encephalopathy.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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