Portal decompression with transjugular intrahepatic portosystemic shunt prior to nonhepatic surgery

Varices commonly occur in liver cirrhosis patients and are classified as esophageal (EV), gastroesophageal (GEV), or isolated gastric (IGV) varices. These vessels may be supplied and drained by several different afferent and efferent pathways. A working knowledge of variceal anatomy is imperative for Interventional Radiologists performing transjugular intrahepatic portosystemic shunt and embolization/obliteration procedures. This pictorial essay characterizes the angiographic anatomy of varices in terms of type and frequency of venous filling and drainage, showing that different varices have distinct vascular anatomy. EVs typically show left gastric vein filling and “uphill” drainage, and GEVs and IGVs exhibit additional posterior/short gastric vein contribution and “downhill” outflow. An understanding of these variceal filling and drainage pathways can facilitate successful portal decompression and embolization/obliteration procedures.

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Portal Decompression by Transjugular Intrahepatic Portosystemic Shunt and Changes in Serum-Ascites Albumin Gradient

Journal of Clinical Gastroenterology ◽

10.1097/00004836-199809000-00010 ◽

1998 ◽

Vol 27 (2) ◽

pp. 149-151 ◽

Cited By ~ 7

Author(s):

Zobair M. Younossi ◽

John G. McHutchison ◽

Crystal Broussard ◽

David Cloutier ◽

Ali Sedghi-Vaziri

Keyword(s):

Transjugular Intrahepatic Portosystemic Shunt ◽

Portosystemic Shunt ◽

Portal Decompression ◽

Intrahepatic Portosystemic Shunt

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Emergent Transjugular Intrahepatic Portosystemic Shunt Creation in Acute Variceal Bleeding

Seminars in Interventional Radiology ◽

10.1055/s-0039-3402015 ◽

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.

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