Transjugular intrahepatic portosystemic shunt placement before abdominal intervention in cirrhotic patients with portal hypertension

2018 ◽  
Vol 30 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Nadim Fares ◽  
Marie-Angèle Robic ◽  
Jean-Marie Péron ◽  
Fabrice Muscari ◽  
Philippe Otal ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Shunt Placement ◽  
Intrahepatic Portosystemic Shunt ◽  
Cirrhotic Patients ◽  
Abdominal Intervention

scholarly journals Systemic and Splanchnic Lipopolysaccharide and Endothelin-1 Plasma Levels in Liver Cirrhosis before and after Transjugular Intrahepatic Portosystemic Shunt

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Jiaxiang Meng ◽  
Qing Wang ◽  
Kai Liu ◽  
Shuofei Yang ◽  
Xinxin Fan ◽  
...  
Keyword(s):  
Blood Flow ◽  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Bacterial Translocation ◽  
Portosystemic Shunt ◽  
Before And After ◽  
Intrahepatic Portosystemic Shunt ◽  
Cirrhotic Patients

Lipopolysaccharide (LPS) and endothelin- (ET-) 1 may aggravate portal hypertension by increasing intrahepatic resistance and splanchnic blood flow. In the portal vein, after TIPS shunting, LPS and ET-1 were significantly decreased. Our study suggests that TIPS can benefit cirrhotic patients not only in high hemodynamics related variceal bleeding but also in intestinal bacterial translocation associated complications such as endotoxemia.

scholarly journals Transjugular Intrahepatic Portosystemic Shunt Placement for Portal Hypertension: Meta-Analysis of Safety and Efficacy of 8 mm vs. 10 mm Stents

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Jiangtao Liu ◽  
Eric Paul Wehrenberg-Klee ◽  
Emily D. Bethea ◽  
Raul N. Uppot ◽  
Kei Yamada ◽  
...  
Keyword(s):  
Overall Survival ◽  
Portal Hypertension ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Meta Analysis ◽  
Portosystemic Shunt ◽  
Refractory Ascites ◽  
Stent Group ◽  
Safety And Efficacy ◽  
Intrahepatic Portosystemic Shunt ◽  
Cirrhotic Patients

Introduction. Hepatic encephalopathy (HE) following transjugular intrahepatic portosystemic shunt (TIPS) placement remains a leading adverse event. Controversy remains regarding the optimal stent diameter given that smaller stents may decrease the amount of shunted blood and decrease the risk of HE, but stent patency and/or clinical adequacy of portal decompression may also be affected. We aim to provide meta-analysis-based evidence regarding the safety and efficacy of 8 mm vs. 10 mm stents during TIPS placement. Methods. PubMed, Embase, Cochrane Library, and Web of Science were searched for studies comparing 8 mm and 10 mm stents during TIPS placement for portal hypertension decompression in cirrhotic patients. Randomized controlled trials and cohort studies were prioritized for inclusion. Overall evaluation of quality and bias for each study was performed. The outcomes assessed were the prevalence of HE, rebleeding or failure to control refractory ascites, and overall survival. Subgroup analysis based on TIPS indication was conducted. Results. Five studies with a total number of 489 cirrhotic patients were identified. The pooled hazard ratio (HR) of post-TIPS HE was significantly lower in patients in the 8 mm stent group than in the 10 mm stent group (HR: 0.68, 95% CI: 0.51~0.92, p value < 0.0001). The combined HR of post-TIPS rebleeding/the need for paracentesis was significantly higher in patients in the 8 mm stent group than in the 10 mm stent group (HR: 1.76, 95% CI: 1.22~2.55, p value < 0.0001). There was no statistically significant difference in the overall survival between the 8 mm and 10 mm stent groups. The combined risk of HE in the variceal bleeding subgroup was statistically lower (HR: 0.52, CI: 0.34-0.80) with an 8 mm stent compared with a 10 mm stent. The combined risk of both rebleeding/paracentesis and survival was not statistically significant between 8 mm and 10 mm stent use in subgroup analysis. Conclusion. 8 mm stents during TIPS placement are associated with a significant lower risk of HE compared to 10 mm stents (32% decreased risk), as well as a 76% increased risk of rebleeding/paracentesis. Meta-analysis results suggest that there is not one superior stent choice for all clinical scenarios and that the TIPS indication of variceal bleeding or refractory ascites might have different appropriate selection of the shunt diameter.

scholarly journals Mortality and complications in patients with portal hypertension who underwent transjugular intrahepatic portosystemic shunt (TIPS) - 12 years experience

2012 ◽  
Vol 49 (2) ◽  
pp. 143-149 ◽  
Author(s):  
Fernanda Ribeiro Funes ◽  
Rita de C. M. A. da Silva ◽  
Paulo César Arroyo Jr. ◽  
William José Duca ◽  
Adinaldo Adhemar Menezes da Silva ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Hepatitis Virus ◽  
Early Death ◽  
Portosystemic Shunt ◽  
University Hospital ◽  
Portal System ◽  
Digestive Hemorrhage ◽  
Intrahepatic Portosystemic Shunt ◽  
Cirrhotic Patients

CONTEXT: Transjugular intrahepatic portosystemic shunt (TIPS) is the non-surgical treatment option with low level of morbi-mortality and possibility of accomplishment in patients with severe hepatic dysfunction which aims at decompressing the portal system treating or reducing the portal hypertension complications. OBJECTIVE: Outline the profile analyze global and early mortality, and the complications presented by cirrhotic patients who underwent TIPS for treatment of digestive hemorrhage by portal hypertension. METHOD: Retrospective study based on the data bank of cirrhotic patients' medical reports, who underwent TIPS for digestive hemorrhage by portal hypertension treatment who did not respond to clinical endoscopic treatment, and were assisted from 1998 to 2010 in the Liver Transplant Service at a university hospital. The study was approved by the Committee of Ethics and Research. RESULTS: The sample was comprised of 72 (84.7%) patients, being 57 (79.2%) males, average age 47.7 years (age range from 16 to 85 years and SD = 13), 21 (29.2%) patients presented liver disease as cause excessive intake of alcoholic drinks; 21 (29.2%) contamination by hepatitis virus, 16 (22.2%) excessive alcohol intake associated with virus and 14 (19.4%) patients presented other causes. As for initial classification, 14 (20%) had Child-Pugh A, 33 (47.1%) Child-Pugh B and 23 (32.9%) Child-Pugh C. Initial MELD was obtained in 68 patients being 37 (54.4%) higher than 15 points while 31 (45.6%) had up to 15 points. Early death occurred in 19 (26.4%). Global mortality occurred in 41 (60.3%). CONCLUSIONS: Mortality is directly related to clinical factors of patients, being Child-Pugh and MELD classifications predictors of mortality, with more impact in patients with Child-Pugh class C and MELD > 15. The complications found were similar to those described in the literature, although the dysfunction by stent stenosis (26.4%) was lower than in the most of the studies and the encephalopathy incidence (58.3%) was higher. Probably, the high incidence of encephalopathy is explained by the low incidence of stenosis.

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