Transjugular Intrahepatic Portosystemic Shunt in Ascites: Updates

2017 ◽  
Vol 01 (04) ◽  
pp. 254-258
Author(s):  
Harry Trieu ◽  
Stephen Kee ◽  
Edward Lee
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
American Association ◽  
Survival Rates ◽  
Covered Stent ◽  
Portosystemic Shunt ◽  
Refractory Ascites ◽  
Covered Stents ◽  
Significant Survival ◽  
Intrahepatic Portosystemic Shunt ◽  
Large Volume Paracentesis

AbstractThe 2009 update of the American Association for the Study of Liver Diseases (practice guidelines recommends transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of refractory ascites in patients who do not tolerate repeated large volume paracentesis (LVP). It also stated uncertain survival benefit and possible increase in the risk of hepatic encephalopathy (HE). Since this update was published, new studies concerning TIPS as therapy for refractory ascites have emerged. Five studies reported a significant survival improvement in patients who underwent TIPS compared with LVP for refractory ascites, while a single study noted improved survival rates in covered stent TIPS recipients. Three studies found a significantly greater prevalence of severe HE in TIPS recipients compared with LVP recipients; however, only one study reported a significant association between TIPS and increased development of HE of all grades. Based on our review of the current literature, we recommend TIPS over LVP for the treatment of refractory ascites. Further, covered stents should be used for TIPS creation whenever possible.

scholarly journals The Evolution of Transjugular Intrahepatic Portosystemic Shunt: Tips

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Fabrizio Fanelli
Keyword(s):  
Stent Graft ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Survival Rates ◽  
Covered Stent ◽  
Portosystemic Shunt ◽  
Noninvasive Technique ◽  
Vein Thrombosis ◽  
Conventional Medical Therapy ◽  
Intrahepatic Portosystemic Shunt ◽  
Covered Stent Graft

Since Richter’s description in the literature in 1989 of the first procedure on human patients, transjugular intrahepatic portosystemic shunt (TIPS) has been worldwide considered as a noninvasive technique to manage portal hypertension complications. TIPS succeeds in lowering the hepatic sinusoidal pressure and in increasing the circulatory flow, thus reducing sodium retention, ascites recurrence, and variceal bleeding. Required several revisions of the shunt TIPS can be performed in case of different conditions such as hepatorenal syndrome, hepatichydrothorax, portal vein thrombosis, and Budd-Chiari syndrome. Most of the previous studies on TIPS procedure were based on the use of bare stents and most patients chose TIPS 2-3 years after traditional treatment, thus making TIPS appear to be not superior to endoscopy in survival rates. Bare stents were associated with higher incidence of shunt failure and consequently patients required several revisions during the follow-up. With the introduction of a dedicated e-PTFE covered stent-graft, these problems were completely solved, No more reinterventions are required with a tremendous improvement of patient’s quality of life. One of the main drawbacks of the use of e-PTFE covered stent-graft is higher incidence of hepatic encephalopathy. In those cases refractory to the conventional medical therapy, a shunt reduction must be performed.

Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experience

2018 ◽  
Vol 36 (3) ◽  
pp. 218-227 ◽  
Author(s):  
Matthias Buechter ◽  
Paul Manka ◽  
Guido Gerken ◽  
Ali Canbay ◽  
Sandra Blomeyer ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Venous Pressure ◽  
Portosystemic Shunt ◽  
Refractory Ascites ◽  
Control Group ◽  
Covered Stents ◽  
Group I ◽  
Intrahepatic Portosystemic Shunt

Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in decompensated portal hypertension. TIPS revision due to thrombosis or stenosis increases morbidity and mortality. Our aim was to investigate patient- and procedure-associated risk factors for TIPS-revision. Patients and Methods: We retrospectively evaluated 189 patients who underwent the TIPS procedure. Only patients who required TIPS revision within 1 year (Group I, 34 patients) and patients who did not require re-intervention within the first year (Group II [control group], 54 patients) were included. Results: Out of 88 patients, the majority were male (69.3%) and mean age was 56 ± 11 years. Indications for TIPS were refractory ascites (68%), bleeding (24%), and Budd-Chiari syndrome (8%). The most frequent liver disease was alcohol-induced cirrhosis (60%). Forty-three patients (49%) received bare and 45 patients (51%) covered stents, thus resulting in reduction of hepatic venous pressure gradient (HVPG) from 19.0 to 9.0 mm Hg. When comparing patient- and procedure-related factors, the type of stent (p < 0.01) and interventionalist’s experience (number of performed TIPS implantations per year; p < 0.05) were the only factors affecting the risk of re-intervention due to stent dysfunction, while age, gender, indication, Child-Pugh, and model of end-stage liver disease score, platelet count, pre- and post-HVPG, additional variceal embolization, stent diameter, and number of stents did not significantly differ. Conclusion: Patients undergoing TIPS procedure should be surveilled closely for shunt dysfunction while covered stents and high-level experience are associated with increased ­patency.

scholarly journals The Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Portal Hypertension: Current Status

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Gilles Pomier-Layrargues ◽  
Louis Bouchard ◽  
Michel Lafortune ◽  
Julien Bissonnette ◽  
Dave Guérette ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Medical Treatment ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Randomized Clinical Trials ◽  
Portosystemic Shunt ◽  
Current Status ◽  
Refractory Ascites ◽  
Covered Stents ◽  
Major Advance ◽  
Intrahepatic Portosystemic Shunt

The transjugular intrahepatic portosystemic shunt (TIPS) represents a major advance in the treatment of complications of portal hypertension. Technical improvements and increased experience over the past 24 years led to improved clinical results and a better definition of the indications for TIPS. Randomized clinical trials indicate that the TIPS procedure is not a first-line therapy for variceal bleeding, but can be used when medical treatment fails, both in the acute situation or to prevent variceal rebleeding. The role of TIPS to treat refractory ascites is probably more justified to improve the quality of life rather than to improve survival, except for patients with preserved liver function. It can be helpful for hepatic hydrothorax and can reverse hepatorenal syndrome in selected cases. It is a good treatment for Budd Chiari syndrome uncontrollable by medical treatment. Careful selection of patients is mandatory before TIPS, and clinical followup is essential to detect and treat complications that may result from TIPS stenosis (which can be prevented by using covered stents) and chronic encephalopathy (which may in severe cases justify reduction or occlusion of the shunt). A multidisciplinary approach, including the resources for liver transplantation, is always required to treat these patients.

scholarly journals Glue Embolization of Gastroesophageal Varices during Transjugular Intrahepatic Portosystemic Shunt (TIPS) Improves Survival Compared to Coil-only Embolization—A Single-Center Retrospective Study

2021 ◽  
Author(s):  
Karsten Wolter ◽  
Michael Praktiknjo ◽  
Julia Boie ◽  
Georges Decker ◽  
Jennifer Nadal ◽  
...  
Keyword(s):  
Overall Survival ◽  
Retrospective Study ◽  
Treatment Failure ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Refractory Ascites ◽  
Secondary Outcome ◽  
Gastroesophageal Varices ◽  
Intrahepatic Portosystemic Shunt ◽  
Glue Embolization

Abstract Purpose To compare the safety and effectiveness of coil versus glue embolization of gastroesophageal varices during transjugular intrahepatic portosystemic shunt (TIPS) creation. Materials and Methods In this monocentric retrospective study 104 (males: 67 (64%)) patients receiving TIPS with concomitant embolization of GEV and a minimum follow-up of one year (2008—2017) were included. Primary outcome parameter was overall survival (6 week; 1 year). Six-week overall survival was assessed as a surrogate for treatment failure as proposed by the international Baveno working group. Secondary outcome parameters were development of acute-on-chronic liver failure (ACLF), variceal rebleeding and hepatic encephalopathy (HE). Survival analysis was performed using Kaplan–Meier with log-rank test and adjusted Cox regression analysis. Results Indications for TIPS were refractory ascites (n = 33) or variceal bleeding (n = 71). Embolization was performed using glue with or without coils (n = 40) (Group G) or coil-only (n = 64) (Group NG). Overall survival was significantly better in group G (p = 0.022; HR = -3.333). Six-week survival was significantly lower in group NG (p = 0.014; HR = 6.945). Rates of development of ACLF were significantly higher in group NG after 6 months (NG = 14; G = 6; p = 0.039; HR = 3.243). Rebleeding rates (NG = 6; G = 3; p = 0.74) and development of HE (NG = 22; G = 15; p = 0.75) did not differ significantly between groups. Conclusion Usage of glue in embolization of GEV may improve overall survival, reduce treatment failure and may be preferable over coil embolization alone.

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