portal decompression
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2022 ◽  
Vol 8 ◽  
Author(s):  
Lukas Sturm ◽  
Dominik Bettinger ◽  
Lisa Roth ◽  
Katharina Zoldan ◽  
Laura Stolz ◽  
...  

Introduction: Despite intensive research, reliable blood-derived parameters to detect clinically significant portal hypertension (CSPH) in patients with cirrhosis are lacking. As altered homeostasis of cyclic guanosine monophosphate (cGMP), the central mediator of vasodilatation, is an essential factor in the pathogenesis of portal hypertension, the aim of our study was to evaluate plasma cGMP as potential biomarker of cirrhotic portal hypertension.Methods: Plasma cGMP was analyzed in cirrhotic patients with CSPH (ascites, n = 39; esophageal varices, n = 31), cirrhotic patients without CSPH (n = 21), patients with chronic liver disease without cirrhosis (n = 11) and healthy controls (n = 8). cGMP was evaluated as predictor of CSPH using logistic regression models. Further, the effect of transjugular intrahepatic portosystemic shunt (TIPS) placement on plasma cGMP was investigated in a subgroup of cirrhotic patients (n = 13).Results: Plasma cGMP was significantly elevated in cirrhotic patients with CSPH compared to cirrhotic patients without CSPH [78.1 (67.6–89.2) pmol/ml vs. 39.1 (35.0–45.3) pmol/l, p < 0.001]. Of note, this effect was consistent in the subgroup of patients with esophageal varices detected at screening endoscopy who had no prior manifestations of portal hypertension (p < 0.001). Cirrhotic patients without CSPH displayed no significant elevation of plasma cGMP compared to patients without cirrhosis (p = 0.347) and healthy controls (p = 0.200). Regression analyses confirmed that cGMP was an independent predictor of CSPH (OR 1.042, 95% CI 1.008–1.078, p = 0.016). Interestingly, portal decompression by TIPS implantation did not lead to normalization of plasma cGMP levels (p = 0.101).Conclusions: Plasma cGMP is a promising biomarker of CSPH in patients with cirrhosis, especially with respect to screening for esophageal varices. The lacking normalization of plasma cGMP after portal decompression suggests that elevated plasma cGMP in cirrhotic portal hypertension is mainly a correlate of systemic and splanchnic vasodilatation, as these alterations have been shown to persist after TIPS implantation.


2021 ◽  
Vol 32 (5) ◽  
pp. S129
Author(s):  
A. Raman ◽  
M. Lad ◽  
N. Parikh ◽  
R. Gupta ◽  
R. Gupta ◽  
...  

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Claus Christian Pieper ◽  
Andreas Feißt ◽  
Carsten Meyer ◽  
Julian Luetkens ◽  
Michael Praktiknjo ◽  
...  

AbstractThe puropse of this study was to evaluate associations of cisterna chyli (CCh) diameter with portal hemodynamics and the influence of TIPS-creation in cirrhotic patients. 93 cirrhotic patients (57 male, mean age 59 years) received CT prior to TIPS-creation. 38/93 additionally underwent post-interventional CT. CCh-diameter was measured. After categorization into patients with and without large venous collaterals (i.e. > 6 mm), data were analyzed regarding associations between CCh-diameter, clinical and portal-hemodynamic parameters and diameter-changes after TIPS-creation. Patient survival post-TIPS was analyzed. Median portosystemic pressure-gradient decreased from 20 to 9 mmHg after TIPS-creation. Large venous collaterals were observed in 59 patients. In 69/93 patients (74.2%) the CCh was detectable. Mean pre-interventional diameter was 9.4 ± 2.7 mm (large collaterals: 8.7 ± 2.0 mm, no large collaterals: 10.7 ± 3.2 mm, p = 0.003). CCh-diameter correlated strongly with pre-TIPS portal-pressure (Rs = 0.685, p = 0.0001), moderately with portosystemic-gradient (Rs = 0.524, p = 0.006), liver shear-wave-elastography (Rs = 0.597, p = 0.004) and spleen size (Rs = 0.501, p = 0.01) in patients without large collaterals, but not in patients with large collaterals. Post-TIPS CCh-diameter decreased significantly from 10.2 ± 2.8 mm to 8.3 ± 3.0 mm (p < 0.001). Patients without a detectable CCh on CT survived significantly shorter. The diameter of the CCh is associated with portal-pressure and decreases after TIPS-creation in cirrhotic patients, reflecting a portal decompression mechanism via the lymphatic system. Lack of larger central lymphatics detectable on CT may be associated with shorter survival.


2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ashish Goel ◽  
Amardeep Khanna ◽  
Homoyon Mehrzad ◽  
Simon Bach ◽  
Salil Karkhanis ◽  
...  

Author(s):  
Pietro Addeo ◽  
Olivier Julliard ◽  
Alfonso Terrone ◽  
Caroline Schaaf ◽  
François Faitot ◽  
...  

2020 ◽  
Vol 37 (01) ◽  
pp. 003-013
Author(s):  
Mithil B. Pandhi ◽  
Andrew J. Kuei ◽  
Andrew J. Lipnik ◽  
Ron C. Gaba

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.


Surgery ◽  
2019 ◽  
Vol 165 (5) ◽  
pp. 970-977 ◽  
Author(s):  
François Faitot ◽  
Pietro Addeo ◽  
Camille Besch ◽  
Baptiste Michard ◽  
Constantin Oncioiu ◽  
...  

2018 ◽  
Vol 29 (6) ◽  
pp. 3273-3280
Author(s):  
Jiaywei Tsauo ◽  
He Zhao ◽  
Xiaowu Zhang ◽  
Huaiyuan Ma ◽  
Mingshan Jiang ◽  
...  

HPB ◽  
2018 ◽  
Vol 20 ◽  
pp. S790
Author(s):  
F. Faitot ◽  
P. Addeo ◽  
C. Oncioui ◽  
E. Felli ◽  
C. Besch ◽  
...  
Keyword(s):  

HPB ◽  
2018 ◽  
Vol 20 ◽  
pp. S439-S440
Author(s):  
V. Gunasekaran ◽  
T.S. Chandrasekar ◽  
T.-M. Ahmed Shaikh ◽  
R. Rajalingam ◽  
G. Narasimhan ◽  
...  

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