scholarly journals The Pull-Through Technique for Recanalization of Transjugular Intrahepatic Portosystemic Shunt Dysfunction

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Si-liang Chen ◽  
Cheng-jiang Xiao ◽  
Shuai Wang ◽  
Si-yi Jin ◽  
Jian-bo Zhao
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Clinical Success ◽  
Primary Patency ◽  
Portosystemic Shunt ◽  
Related Complication ◽  
Primary Patency Rate ◽  
Intrahepatic Portosystemic Shunt ◽  
Shunt Dysfunction ◽  
Pull Through

Purpose. To evaluate the technical efficacy and safety of the pull-through technique in recanalization of transjugular intrahepatic portosystemic shunt (TIPS) when standard transjugular approach is inaccessible. Materials and Methods. A retrospective review of patients underwent TIPS revision via the pull-through technique was performed. Transhepatic directly punctured stent was conducted if the portal vein could not be accessed via standard transjugular approach. Technical success was defined by recanalization of shunt. Clinical success was defined as bleeding interruption and ascites regression without pharmacological support. All patients were followed up by clinical evaluation and Doppler ultrasound. Results. Between January 2010 and December 2016, a total of 63 patients underwent TIPS revision, and 14 of them could not be accessed via standard transjugular approaches owing to stenosis or occlusion of the hepatic vein. The pull-through technique was successful in 13 patients, and one patient underwent parallel TIPS. No procedure-related complication was observed. One patient died of liver failure one week after the procedure. During the follow-up, three patients developed hepatic encephalopathy, and one patient developed TIPS dysfunction again and experienced variceal bleeding. The primary patency rate after TIPS revision was 92% (11/12) at 12 months. Conclusion. The pull-through technique was effective and safe for recanalization of TIPS inaccessible via standard transjugular approach.

scholarly journals Whether Gastrorenal Shunt Embolization Would Benefit the Outcomes of Post Transjugular Intrahepatic Portosystemic Shunt

2021 ◽  
Author(s):  
Dongmei Zhao ◽  
Mingquan Wang ◽  
Guosheng Chen ◽  
Guobing Zhang ◽  
Chaoxue Zhang ◽  
...  
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Reference Group ◽  
Tertiary Care ◽  
Portosystemic Shunt ◽  
Clinical Relapse ◽  
Portosystemic Shunts ◽  
Significant Difference ◽  
Intrahepatic Portosystemic Shunt ◽  
Shunt Dysfunction

Abstract Background & Aim: Whether the spontaneous portosystemic shunts in cirrhosis who require embolization during transjugular intrahepatic portosystemic shunt (TIPS) remains a therapeutic controversial. This study was retrospectively conducted to evaluate the effectiveness of the gastrorenal shunts (GRS) embolization in cirrhosis post-TIPS。Methods: 70 cirrhotic patients who underwent TIPS in a tertiary-care center were included, of which 43 patients had no GRS and 27 had GRS with embolization during TIPS placement. Then, to assess the outcomes of embolization of GRS on post-TIPS hepatic encephalopathy (HE), clinical relapse, mortality and shunt dysfunction.Results: During a median follow-up period of 497.01 days, 25 patients (35.7%) experienced HE, of 14 patients in GRS group and 11 in another (p = 0.026). Within 50 days after TIPS, 12 patients performed initial HE in GRS group while 6 in the reference group (p < 0.001). After TIPS of 150th to 200th, one in the former group and five in another experienced HE (p < 0.001). However, there was no significant difference in the 1-year cumulative risk of HE (p = 0.287). Meanwhile, during the 2-year follow-up, the patients performed lower incidence of ascites after GRS embolization with TIPS (p < 0.002). And there was no difference in rebleeding, mortality and shunt dysfunction. Conclusions: TIPS with GRS embolization appeared to be a safe and efficacious procedure in the treatment of portal hypertension with concomitant GRS. Furthermore, the procedure seemed to reduce the recurrences of ascites for a long term observation.

scholarly journals Cardiovascular magnetic resonance demonstrates structural cardiac changes following transjugular intrahepatic portosystemic shunt

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ulf K. Radunski ◽  
Johannes Kluwe ◽  
Malte Klein ◽  
Antonio Galante ◽  
Gunnar K. Lund ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Troponin T ◽  
Left Ventricular ◽  
Portosystemic Shunt ◽  
Native T1 ◽  
Intrahepatic Portosystemic Shunt

AbstractTransjugular intrahepatic portosystemic shunt (TIPS) reduces portal hypertension in patients with liver cirrhosis. The exact cardiac consequences of subsequent increase of central blood volume are unknown. Cardiovascular magnetic resonance (CMR) imaging is the method of choice for quantifying cardiac volumes and ventricular function. The aim of this study was to investigate effects of TIPS on the heart using CMR, laboratory, and imaging cardiac biomarkers. 34 consecutive patients with liver cirrhosis were evaluated for TIPS. Comprehensive CMR with native T1 mapping, transthoracic echocardiography, and laboratory biomarkers were assessed before and after TIPS insertion. Follow-up (FU) CMR was obtained in 16 patients (47%) 207 (170–245) days after TIPS. From baseline (BL) to FU, a significant increase of all indexed cardiac chamber volumes was observed (all P < 0.05). Left ventricular (LV) end-diastolic mass index increased significantly from 45 (38–51) to 65 (51–73) g/m2 (P =  < 0.01). Biventricular systolic function, NT-proBNP, high-sensitive troponin T, and native T1 time did not differ significantly from BL to FU. No patient experienced cardiac decompensation following TIPS. In conclusion, in patients without clinically significant prior heart disease, increased cardiac preload after TIPS resulted in increased volumes of all cardiac chambers and eccentric LV hypertrophy, without leading to cardiac impairment during follow-up in this selected patient population.

scholarly journals Effectiveness of Transjugular Intrahepatic Portosystemic Shunt in Variceal Bleeding: An Audit from a Tertiary Care Center in North India

2017 ◽  
Vol 01 (03) ◽  
pp. 150-155
Author(s):  
Arun Gupta ◽  
Ajay Mehta ◽  
Nitin Mishra ◽  
Rajendra Bansal ◽  
Ajit Yadav
Keyword(s):  
Variceal Bleeding ◽  
Patency Rate ◽  
Care Center ◽  
Tertiary Care ◽  
Portosystemic Shunt ◽  
North India ◽  
Related Complication ◽  
Variceal Bleed ◽  
Intrahepatic Portosystemic Shunt

AbstractVariceal bleeding is one of the most feared complications of cirrhosis and portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective minimally invasive option to achieve adequate decompression of the portal system. The aim of the study was to assess the efficacy and complications of TIPS in patients presenting with variceal bleed. It was a retrospective study done in a tertiary care center in North India in cirrhotic patients with acute or recurrent variceal bleed who underwent TIPS from April 2010 to October 2013. All the patients were followed up till April 2014. We could successfully implant TIPS in 100% of our patients with 100% success rate in controlling variceal bleeding immediately and during the follow-up period. Our primary patency rate was 94.5% and overall patency rate was 100%. Major TIPS-related complication was hepatic encephalopathy in 20% of patients; 7 of 22 patients died during the follow-up period. TIPS is a safe and effective procedure for control of acute or recurrent variceal bleed. Emerging evidence in favor of early TIPS is further going to expand its indication in variceal bleed. Hepatic encephalopathy was the major procedure-related complication in our study consistent with previous literature reports.

scholarly journals Transjugular Intrahepatic Portosystemic Shunt for Hepatic Sinusoidal Obstruction Syndrome Associated with Consumption of Gynura Segetum

2020 ◽  
Author(s):  
Lijie Zhang ◽  
Qing Li ◽  
Joyman Makamure ◽  
Dan Zhao ◽  
Ziyi Liu ◽  
...  
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Total Bilirubin ◽  
Portosystemic Shunt ◽  
Sinusoidal Obstruction Syndrome ◽  
Liver Size ◽  
Hepatic Sinusoidal Obstruction Syndrome ◽  
Intrahepatic Portosystemic Shunt ◽  
Vein Diameter ◽  
Lost To Follow Up

Abstract Background: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) on hepatic sinusoidal obstruction syndrome (HSOS) associated with consumption of Gynura segetum (GS).Methods: We retrospectively reviewed 9 consecutive patients with GS-related HSOS who were refractory to supportive treatment and underwent TIPS at our institution between January 2014 and September 2019. The patients were evaluated for safety and efficacy, including TIPS complications and changes in portosystemic pressure gradient (PPG), ascites, total bilirubin, liver size and portal vein diameter.Results: TIPS procedures were performed successfully in the 9 patients, without any TIPS technique-related complications. The PPG was improved by TIPS in all patients (mean PPG before TIPS, 30.4 ± 5.2 vs. 13.0 ± 4.1 mm Hg post-TIPS, P=0.008). Except for one patient who was lost to follow-up, the remaining 8 patients survived with a median follow-up period of 12 months (range, 5-39 months). Although the level of total bilirubin was significantly increased 5-7 days after TIPS compared with that before the procedure (3.57 ± 1.58 vs. 4.82 ± 2.06 mg/dl, P=0.017), it returned to baseline level at 1-month follow-up (3.53 ± 2.72 vs. 4.82 ± 2.06 mg/dl, P=0.401). The patients experienced complete resolution or obvious reduction of ascites (P<0.001), significant reduction of liver size (16.7 ± 2.2 vs. 13.7 ± 1.7 cm, P=0.018), and significant enlargement of the portal trunk (10.7 ± 2.5 vs. 13.4 ± 2.4 mm, P=0.017) after TIPS compared to the pre-TIPS state.Conclusion: TIPS may offer a potentially useful treatment for the GS-related HSOS.

Performance of ultrasound for detection of transjugular intrahepatic portosystemic shunt dysfunction: a meta-analysis

2019 ◽  
Vol 44 (7) ◽  
pp. 2392-2402 ◽  
Author(s):  
Wuttiporn Manatsathit ◽  
Hrishikesh Samant ◽  
Panadeekarn Panjawatanan ◽  
Annie Braseth ◽  
Jane Suh ◽  
...  
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Meta Analysis ◽  
Portosystemic Shunt ◽  
Intrahepatic Portosystemic Shunt ◽  
Shunt Dysfunction
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