scholarly journals Evolution of Retrograde Transvenous Obliteration Techniques

2018 ◽  
Vol 35 (03) ◽  
pp. 185-193 ◽  
Author(s):  
Christopher Molvar ◽  
Mihir Patel
Keyword(s):  
Portal Pressure ◽  
Hepatic Function ◽  
Portosystemic Shunt ◽  
Variceal Hemorrhage ◽  
Esophageal Variceal ◽  
Gastrorenal Shunt ◽  
Life Threatening ◽  
Intrahepatic Portosystemic Shunt ◽  
Life Threatening Complication ◽  
Gastric Variceal Hemorrhage

AbstractGastric variceal hemorrhage is a life-threatening complication of portal hypertension with a poorer prognosis compared with esophageal variceal hemorrhage. The presence of an infradiaphragmatic portosystemic shunt, often a gastrorenal shunt, allows for treatment with retrograde transvenous obliteration (RTO). RTO is an evolving treatment strategy, which includes balloon-assisted RTO, plug-assisted RTO, and coil-assisted RTO, for both gastric variceal hemorrhage and hepatic encephalopathy. RTO techniques are less invasive than transjugular intrahepatic portosystemic shunt creation, with the benefit of improved hepatic function, but at the expense of increased portal pressure. This article discusses the techniques of RTO, including patient eligibility, as well as technical and clinical outcomes, including adverse events.

TIPS in the Treatment of Variceal Bleeding

2017 ◽  
Vol 01 (04) ◽  
pp. 265-271
Author(s):  
Joseph Morrison ◽  
Andrew Lipnik ◽  
Ron Gaba
Keyword(s):  
Variceal Bleeding ◽  
Selection Criteria ◽  
Gastric Varices ◽  
Portosystemic Shunt ◽  
Variceal Hemorrhage ◽  
Life Threatening ◽  
Intrahepatic Portosystemic Shunt ◽  
Patient Selection Criteria ◽  
Early Tips

AbstractVariceal bleeding is a life-threatening complication of portal hypertension. In recent years, transjugular intrahepatic portosystemic shunt (TIPS) creation has cemented a role in the management of acute refractory bleeding and recurrent variceal hemorrhage. This article aims to review the use of TIPS in patients with variceal bleeding, with a focus on accepted procedure indications, patient selection criteria, TIPS technique, clinical outcomes, and contemporary issues, such as early TIPS in acute variceal hemorrhage, the role of adjuvant embolotherapy, and TIPS utility for gastric varices.

Does Transjugular Intrahepatic Portosystemic Shunt Stent Differentially Improve Survival in a Subset of Cirrhotic Patients?

2018 ◽  
Vol 38 (01) ◽  
pp. 087-096 ◽  
Author(s):  
Jonel Trebicka
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Portosystemic Shunt ◽  
Refractory Ascites ◽  
Variceal Hemorrhage ◽  
Early Evaluation ◽  
Vein Thrombosis ◽  
Intrahepatic Portosystemic Shunt

AbstractDoes transjugular intrahepatic portosystemic shunt stent (TIPS) improve survival in a subgroup of patients? Yes. TIPS nearly halves portal pressure and increases the effective blood volume. In cases of acute variceal hemorrhage and with a high risk of treatment failure, defined as either hepatic venous pressure gradient higher than 20 mm Hg, Child B with active bleeding at the endoscopy, or Child C with less than 14 points, early or preemptive placement of TIPS (within 72 hours) improves survival. Also, in suitable patients with intractable or refractory ascites, TIPS improves survival if placed early in the course of treatment. While TIPS does not improve survival in other situations, it improves disease management, especially in patients without TIPS contraindications but with refractory bleeding, early rebleeding, portal vein thrombosis, and hepatorenal syndrome. Experience gained at the centers and follow-up of TIPS patients are key features that improve outcome. Important factors for selection and follow-up include cardiac function, inflammation, sarcopenia, age, and early evaluation for liver transplantation.

scholarly journals Successful Reversal of Chronic Incapacitating Post-TIPS Encephalopathy by Balloon Occlusion of the Stent

1994 ◽  
Vol 8 (2) ◽  
pp. 75-80 ◽  
Author(s):  
Daphna Fenyves ◽  
Michel P Dufresne ◽  
Jean Raymond ◽  
Michel Lafortune ◽  
Bernard Willems ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Balloon Occlusion ◽  
Portosystemic Shunt ◽  
Portal System ◽  
Variceal Hemorrhage ◽  
General Anesthetic ◽  
Portal Flow ◽  
Life Threatening ◽  
Intrahepatic Portosystemic Shunt ◽  
A New Technique

Transjugular intrahepatic portosystemic shunt (TIPS) placement is a new technique allowing decompression of the portal system without the need for abdominal surgery or general anesthetic. This promising procedure appears safe, and is being evaluated in the context of life threatening uncontrollable variceal hemorrhage as well as ascites refractory to medical treatment. Following TIPS, portal flow diversion is associated with hepatic encephalopathy in up to 25% of patients. This is most often mild and treatable but may become uncontrollable, incapacitating and even life threatening in up to 3 to 5% of cases. The authors present two patients in whom such life threatening encephalopathy and stupor was reversed by transjugular balloon occlusion of the TIPS.

Variceal Hemorrhage: Decompression, Obliteration, or Both?

2022 ◽  
Author(s):  
Benjamin J. McCafferty ◽  
Husamedin El Khudari ◽  
Aliaksei Salei ◽  
Andrew J. Gunn
Keyword(s):  
Interventional Radiology ◽  
Patient Outcomes ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Clinical Management ◽  
Portosystemic Shunt ◽  
Variceal Hemorrhage ◽  
Morbid Condition ◽  
Image Guided ◽  
Primary Image ◽  
Intrahepatic Portosystemic Shunt

AbstractVariceal hemorrhage is a morbid condition that frequently mandates the involvement of interventional radiology to achieve successful and sustained hemostasis. Primary image-guided therapies for variceal hemorrhage include a transjugular intrahepatic portosystemic shunt and transvenous obliteration. Knowledge of variceal pathophysiology and anatomy, current techniques, and the evidence supporting therapeutic selection is paramount to successful patient outcomes. The purpose of this review is to provide the reader a framework of the available literature on image-guided management of bleeding varices to assist in clinical management.

scholarly journals Medical Management of Variceal Bleeding in Patients with Cirrhosis

2004 ◽  
Vol 18 (2) ◽  
pp. 109-113 ◽  
Author(s):  
Juan G Abraldes ◽  
Alessandra Dell'Era ◽  
Jaime Bosch
Keyword(s):  
Variceal Bleeding ◽  
Endoscopic Therapy ◽  
Portal Pressure ◽  
Portosystemic Shunt ◽  
Factor Vii ◽  
Injection Sclerotherapy ◽  
Variceal Hemorrhage ◽  
Elastic Band ◽  
Recombinant Activated Factor Vii ◽  
Gastroesophageal Varices

Bleeding from gastroesophageal varices is a frequent and often deadly complication of cirrhosis. The key factor in the natural history of esophageal varices is increased portal pressure, which in cirrhosis is due to the combination of increased hepatic vascular resistance and increased portal collateral blood flow. The maintenance and aggravation of this situation leads to the progressive dilation of the varices and thinning of the variceal wall, until the tension exerted by the variceal wall exceeds the elastic limit of the vessel, leading to variceal hemorrhage. Mortality from a variceal bleeding episode has decreased in the last two decades from 40% to 20% due to the implementation of effective treatments and improvement in the general medical care. Initial treatment should include adequate fluid resuscitation and transfusion to maintain the hematocrit at 25% to 30%, and prophylactic antibiotics (norfloxacin or amoxicillin-clavulanic acid). It is currently recommended that a vasoactive drug be started at the time of admission. Drug therapy may be started during transferal to hospital by medical or paramedical personnel and maintained for up to five days to prevent early rebleeding. Terlipressin, a vasopressin derivative, is the preferred agent because of its safety profile and proven efficacy in improving survival. Somatostatin is as effective as terlipressin, but may require higher than the usually recommended dosage. Octreotide is effective in conjunction with endoscopic therapy, but is the second choice because it has not been shown to reduce mortality. Vasopressin may be used where terlipressin is not available, but should be given in combination with transdermal nitroglycerin. Endoscopic elastic band ligation is the recommended endoscopic treatment, but injection sclerotherapy is still employed in many centres for active variceal bleeding. Failures of medical therapy (drugs plus endoscopic therapy) should undergo a second course of endoscopic therapy before proceeding to transjugular intrahepatic portosystemic shunt or, in rare occasions, to portosystemic shunt surgery. Administration of recombinant activated factor VII may decrease the number of treatment failures among patients with advanced liver failure (Child-Pugh class B and C).

Adjustable Small-Diameter TIPS

2018 ◽  
Author(s):  
Zubin Irani ◽  
Sara Zhao
Keyword(s):  
Hepatic Encephalopathy ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Small Diameter ◽  
Portosystemic Shunt ◽  
Shunt Revision ◽  
Metal Stents ◽  
Ptfe Graft ◽  
Variceal Hemorrhage ◽  
Graft Material ◽  
Intrahepatic Portosystemic Shunt

Transjugular intrahepatic portosystemic shunt (TIPS) was first described by Rosch et al. in 1969, and in 1982, Colopinto et al. described its first clinical application in a patient with cirrhosis and variceal hemorrhage. It was not until 1988 that the first metal-lined shunt was created, and in 1997 the first polytetrafluoroethylene (PTFE)-lined stent was used in humans for shunt revision after stenosis, created by pinning the Gore PTFE graft material between two metal stents. Introduced in 2000, the Viatorr stent graft is now the most commonly used device for TIPS. One of the major side effects of TIPS creation is hepatic encephalopathy (HE). This chapter discusses the adjustable small-diameter transjugular intrahepatic portosystemic shunt.

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