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.

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.

scholarly journals Transjugular Intrahepatic Portosystemic Shunt (TIPS): Pathophysiologic Basics, Actual Indications and Results with Review of the Literature

2018 ◽  
Vol 190 (08) ◽  
pp. 701-711 ◽  
Author(s):  
Holger Strunk ◽  
Milka Marinova
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Endoscopic Therapy ◽  
Secondary Prophylaxis ◽  
Portosystemic Shunt ◽  
Refractory Ascites ◽  
Variceal Hemorrhage ◽  
Line Therapy ◽  
Intrahepatic Portosystemic Shunt ◽  
Pugh Class ◽  
Early Tips

Background Transjugular intrahepatic portosystemic shunt (TIPS) is a non-selective portosystemic shunt created using endovascular techniques. During recent years technical improvements and new insights into pathophysiology have modified indications for TIPS placement. In this article we therefore want to discuss current knowledge. Method A literature review was performed to review and discuss the pathophysiology, indications and results of the TIPS procedure. Results Established TIPS indications are persistent bleeding despite combined pharmacological and endoscopic therapy and rebleeding during the first five days. A new indication in the European recommendations is early TIPS placement within 72 hours, ideally within 24 hours, in patients bleeding from esophageal or gastroesophageal varices at high risk for treatment failure (e. g. Child-Pugh class C < 14 points or Child-Pugh class B with active bleeding) after initial pharmacological and endoscopic therapy. For prevention of recurrent variceal hemorrhage in the recommendations, covered TIPS placement is the treatment of choice only after failed first-line therapy, although numerous TIPS studies show a prolonged time to rebleeding and a reduction of mortality. Similarly for secondary prophylaxis in patients with refractory ascites, covered TIPS placement may be considered only if the patient continues to be intolerant to NSBBs and is an appropriate TIPS candidate even though studies show that the TIPS procedure controls ascites, improves survival and renal function better than paracentesis. Potential indications for TIPS implantation are Budd-Chiari syndrome, acute portal vein thromboses, hydrothorax, hepatopulmonary and hepatorenal syndrome (Typ 2), portal hypertensive gastropathy (PHG) and prophylaxis of complications of abdominal surgery, very rarely bleeding in ectopic varices or in patients with chylothorax or chylous ascites. Conclusion TIPS placement is an established procedure with a new indication as “early TIPS”. In the European recommendations it is only the second-line therapy for prevention of recurrent variceal hemorrhage and for secondary prophylaxis in patients with refractory ascites although several studies showed a clear benefit of the TIPS procedure compared to ligation and NSBBs. Key Points  Citation Format

scholarly journals Emergent Transjugular Intrahepatic Portosystemic Shunt Creation in Acute Variceal Bleeding

2020 ◽  
Vol 37 (01) ◽  
pp. 003-013
Author(s):  
Mithil B. Pandhi ◽  
Andrew J. Kuei ◽  
Andrew J. Lipnik ◽  
Ron C. Gaba
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Pharmacologic Therapy ◽  
Variceal Hemorrhage ◽  
Gastroesophageal Varices ◽  
Portal Decompression ◽  
Intrahepatic Portosystemic Shunt ◽  
History Of ◽  
Early Tips

AbstractEmergent transjugular intrahepatic portosystemic shunt (TIPS) creation is most commonly employed in the setting of acute variceal hemorrhage. Given a propensity for decompensation, these patients often require a multidisciplinary, multimodal approach involving prompt diagnosis, pharmacologic therapy, and endoscopic intervention. While successful in the majority of cases, failure to medically control initial bleeding can prompt interventional radiology consultation for emergent portal decompression via TIPS creation. This article discusses TIPS creation in emergent, acute variceal hemorrhage, reviewing the natural history of gastroesophageal varices, presentation and diagnosis of acute variceal hemorrhage, pharmacologic therapy, endoscopic approaches, patient selection and risk stratification for TIPS, technical considerations for TIPS creation, adjunctive embolotherapy, and the role of salvage TIPS versus early TIPS in acute variceal hemorrhage.

scholarly journals Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotherapy for the prevention of variceal rebleeding after recent variceal hemorrhage

Hepatology ◽  
1999 ◽  
Vol 29 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Luis García-Villarreal ◽  
Francisco Martínez-Lagares ◽  
Angel Sierra ◽  
Clemencia Guevara ◽  
José M. Marrero ◽  
...  
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Endoscopic Sclerotherapy ◽  
Variceal Hemorrhage ◽  
Intrahepatic Portosystemic Shunt
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