scholarly journals Bleeding due to ectopic varices in a urinary diversion: A multidisciplinary diagnostic and therapeutic challenge

2015 ◽  
Vol 9 (11-12) ◽  
pp. 897
Author(s):  
Eduardo Mariano Albers Acosta ◽  
Alfonsi Friera Reyes ◽  
Ricardo Brime Menéndez
Keyword(s):  
Portal Hypertension ◽  
Urinary Diversion ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Recurrent Bleeding ◽  
Gi Tract ◽  
Ectopic Varices ◽  
Life Threatening ◽  
Intrahepatic Portosystemic Shunt ◽  
Urological Emergency

The ectopic varices in patients with portal hypertension are those that occur at any level of the gastrointestinal (GI) tract, regardless of the varices that occur at the esophageal level. These ectopic varices account for 2‒5% of the causes of GI bleeding varices. The risk of bleeding is quadrupled compared to the esophagogastric area, with a mortality of up to 40%. The transjugular intrahepatic portosystemic shunt, should be considered in cases secondary to recurrent bleeding varices. We present a case report of an urological emergency of bleeding in a urinary diversion secondary to ectopic varices successfully treated through the placement of transjugular intrahepatic portosystemic shunt. The condition described here is rare, but important, as it can be a life-threatening complication of portal hypertension. This kind of complication should be known by urologic surgeons managing patients with urinary diversions.

TIPS: a new alternative for the variceal bleeder

1993 ◽  
Vol 2 (3) ◽  
pp. 196-201 ◽  
Author(s):  
L Adams ◽  
MC Soulen
Keyword(s):  
Portal Hypertension ◽  
Hepatic Vein ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Variceal Bleeding ◽  
Balloon Catheter ◽  
Portosystemic Shunt ◽  
Recurrent Bleeding ◽  
Secondary Patency ◽  
Secondary Patency Rate ◽  
Intrahepatic Portosystemic Shunt

BACKGROUND: Standard medical therapies for variceal bleeding secondary to portal hypertension (vasopressin, esophagogastric balloon tamponade and sclerotherapy) are associated with high rates of recurrent bleeding. Surgical shunting has a mortality rate of 15% to 50%. The transjugular intrahepatic portosystemic shunt offers a novel, minimally invasive procedure for nonsurgical portal decompression. METHOD: Following catheterization of the hepatic vein from a jugular vein approach, a needle is directed fluoroscopically from the hepatic vein into a branch of the portal vein along an intrahepatic tract. The intrahepatic tract is then dilated and held open with a stainless steel stent delivered on a balloon catheter. This creates a portosystemic shunt entirely within the liver. RESULTS: The collective experience of more than 300 cases from several centers has been reported. The technical success rate for the transjugular intrahepatic portosystemic shunt is 92% to 96%. Thirty-day mortality rates range from 0% to 14%, with less than 3% attributed to procedural complications. Primary shunt patency is about 90%, with a secondary patency rate of 100%. Rates of encephalopathy and rebleeding are 9% to 14%. Ascites resolves in 80% to 90% of patients. CONCLUSION: The transjugular intrahepatic portosystemic shunt appears to be a safe and effective procedure for management of variceal bleeding and holds promise for becoming the treatment of choice for portal hypertension.

Transjugular intrahepatic portosystemic shunt in the treatment of ectopic varices secondary to portal hypertension

2003 ◽  
Vol 124 (4) ◽  
pp. A665
Author(s):  
Ramasamy Saravanan ◽  
Manu Nayar ◽  
Peter Rowlands ◽  
Richard Mc Williams ◽  
Howard Smart ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Ectopic Varices ◽  
Intrahepatic Portosystemic Shunt

scholarly journals Twitter debate: controversies in the management of portal hypertension

2020 ◽  
Vol 12 (1) ◽  
pp. 77-79
Author(s):  
William Chung ◽  
James Maurice ◽  
David Patch
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Basic Principles ◽  
Vein Thrombosis ◽  
Ectopic Varices ◽  
In Series ◽  
Intrahepatic Portosystemic Shunt ◽  
Key Topics

The latest ‘Controversies in…’ series for the Frontline Gastroenterology Twitter debates addressed the challenges of managing patients with portal hypertension, facilitated by Hepatologist and Liver Transplant physician Dr David Patch from the Royal Free London. Key topics discussed include basic principles of managing a patient with variceal bleeding, techniques for treating oesophageal and ectopic varices, pitfalls of vasoactive therapy, indications for transjugular intrahepatic portosystemic shunt, and a brief discussion of portal vein thrombosis. This article aims to summarise key areas of discussion from the event.

Transjugular intrahepatic portosystemic shunt for treatment of bleeding ectopic varices with portal hypertension

1999 ◽  
Vol 42 (12) ◽  
pp. 1581-1585 ◽  
Author(s):  
David Shibata ◽  
David P. Brophy ◽  
Fredric D. Gordon ◽  
Harry T. Anastopoulos ◽  
Stephen M. Sentovich ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Ectopic Varices ◽  
Intrahepatic Portosystemic Shunt

Risk Factors for Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Patients with Hepatocellular Carcinoma and Portal Hypertension

2015 ◽  
Vol 24 (3) ◽  
pp. 301-307 ◽  
Author(s):  
Jiannan Yao ◽  
Li Zuo ◽  
Guangyu An ◽  
Zhendong Yue ◽  
Hongwei Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Pressure Gradient ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Meld Score ◽  
Portosystemic Shunt ◽  
Portal Flow ◽  
Intrahepatic Portosystemic Shunt

Aims: This study aimed at assessing the risk factors for hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatocellular carcinoma (HCC) and portal hypertension. Method: Consecutive patients (n=279) with primary HCC who underwent TIPS between January 1997 and March 2012 at a single institution were retrospectively reviewed. Patients were followed up for 2 years. Pre-TIPS, peri-TIPS and post-TIPS clinical variables were reviewed using univariate and multivariate analyses to identify risk factors for HE after TIPS. Results: The overall incidence of HE was 41% (114/279). Multivariate analysis showed an increased odds for HE in patients with: >3 treatments with transcatheter arterial chemoembolization (TACE) and/or trans-arterial embolization (TAE) (odds ratio [OR], 4.078; 95% confidence interval [95%CI], 1.748-9.515); hepatopetal portal flow (OR, 2.362; 95%CI, 1.032-5.404); high portosystemic pressure gradient (OR, 1.198; 95%CI, 1.073-1.336) and high pre-TIPS MELD score (OR, 1.693; 95%CI, 1.390-2.062). Odds for HE were increased 1.693 fold for each 1-point increase in the MELD score, and 1.198 fold for each 1-mmHg decrease in the post-TIPS portosystemic pressure gradient. Conclusion: The identification of clinical variables associated with increased odds of HE may be useful for the selection of appropriate candidates for TIPS. Results suggest that an inappropriate decrease in the portosystemic pressure gradient might be associated with HE after TIPS. In addition, >3 treatments with TACE/TAE, hepatopetal portal flow, and high MELD score were also associated with increased odds of HE after TIPS. Key words:  –  –  – .

scholarly journals MesoTIPS: Combined Approach for the Treatment of Portal Hypertension Secondary to Portal Vein Thrombosis – A Brief Report

2017 ◽  
Vol 01 (01) ◽  
pp. 20-26
Author(s):  
Abbas Chamsuddin ◽  
Lama Nazzal ◽  
Thomas Heffron ◽  
Osama Gaber ◽  
Raja Achou ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Vein Thrombosis ◽  
Intrahepatic Portosystemic Shunt ◽  
The Right ◽  
Minilaparotomy Approach ◽  
Mean Time

AbstractIntroduction: We describe a technique we call “Meso-transjugular intrahepatic portosystemic shunt (MTIPS)” for relief of portal hypertension secondary to portal vein thrombosis (PVT) using combined surgical and endovascular technique. Materials and Methods: Nine adult patients with PVT underwent transjugular intrahepatic portosystemic shunt through a combined transjugular and mesenteric approach (MTIPS), in which a peripheral mesenteric vein was exposed through a minilaparotomy approach. The right hepatic vein was accessed through a transjugular approach. Mechanical thrombectomy, thrombolysis, and angioplasty were performed when feasible to clear PVT. Results: All patients had technically successful procedures. Patients were followed up for a mean time of 13.3 months (range: 8 days to 3 years). All patients are still alive and asymptomatic. Conclusion: We conclude that MTIPS is effective for the relief of portal hypertension secondary to PVT.

scholarly journals Percutaneous Thrombin Injection for Treatment of a Hepatic Arterial Pseudoaneurysm after the Placement of a Transjugular Intrahepatic Portosystemic Shunt

2019 ◽  
Vol 9 ◽  
pp. 20 ◽  
Author(s):  
Daniel C. Oppenheimer ◽  
Luann Jones ◽  
Ashwani Sharma
Keyword(s):  
Portal Hypertension ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Thrombin Injection ◽  
Portal Venous Flow ◽  
Venous Flow ◽  
Artery Pseudoaneurysm ◽  
Imaging Guidance ◽  
Intrahepatic Portosystemic Shunt ◽  
Percutaneous Thrombin Injection

Transjugular intrahepatic portosystemic shunt (TIPS) is a widely accepted option for treating the complications of portal hypertension. The procedure involves creating a communication between the portal and hepatic venous systems using imaging guidance, thereby diverting the portal venous flow and reducing the portosystemic gradient. However, as with any procedure, TIPS insertion is not without potential complications. We present a case of a 37-year-old female who developed a hepatic artery pseudoaneurysm following the placement of a TIPS which was successfully treated with percutaneous thrombin injection.

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