Portal hypertension and surgery on the patient with cirrhosis

Fink, Michael A

doi:10.1002/9781119468189.ch24

Cited by 1 publication

(2 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Необходимость портосистемного шунтирующего вмешательства при осложненном течении портальной гипертензии (ПГ), вызванной циррозом печени (ЦП), в настоящее время не вызывает сомнений у специалистов [1,2]. Миниинвазивный вариант шунтирующего пособия, а именно трансъюгулярное внутрипеченочное портосистемное шунтирование (Transjugular Intrahepatic Portosystemic Shunt, TIPS), является важным элементом программы лечения пациента с продвинутой стадией ЦП [3,4].…”

Section: вве де ниеunclassified

“…Для эмболизации путей притока к ПЖВ предпочтение отдавали эмболизирующим спиралям модели MReye ® (Cook, США), поскольку их длинные волокна обеспечивают хорошую тромбогенность. Число спиралей, применяемых во время операции, зависело от выявленных путей притока, их диаметра и характера ветвления, в среднем составило 4,7 ± 2,9 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Section: материал и методыunclassified

See 1 more Smart Citation

Selection of a portosystemic shunt placement procedure (TIPS) in the treatment of complicated portal hypertension

et al. 2022

View full text Add to dashboard Cite

Aim. To improve treatment results in patients with the life-threatening complications of cirrhotic portal hypertension by making an informed choice of the optimal TIPS (transjugular intrahepatic portosystemic shunt) variant.Materials and methods. A total of 234 patients suffering from the complications of cirrhotic portal hypertension underwent TIPS placement. The indications for shunt placement include esophageal and gastric varices exhibiting the signs of bleeding or carrying the risk of rebleeding (in 172 patients), refractory ascites (in 57 patients), and portal vein thrombosis in the setting of cirrhosis (in 5 patients). Patients from Group 1 underwent shunt placement together with the embolization of inflow pathways to esophageal and gastric varices. In Group 2, priority was given to perioperative therapy, while shunt placement was used together with embolization only in cases of severe varices. In Group 3, the shunt placement stage was combined with the portal blood flow restoration. Immediate and late results were studied in terms of complications, as well as mortality rate and survival rates.Results. The maximum observation duration amounted to 140 months (11.7 years). TIPS efficacy in all patients was confirmed by a statistically significant decrease in the portosystemic pressure gradient. In Group 1, the highest mortality rate associated with rebleeding was observed in patients who had undergone only shunt placement (30.6%), while the lowest rate was noted in patients whose inflow pathways to varices had first been embolized and who then had undergone intrahepatic shunt placement (7.1%). Patients in Group 2 exhibited a reduction in ascites and the severity of varices. The technical feasibility of TIPS in the setting of portal vein thrombosis was enhanced by experience accumulation and preoperative planning relying on careful interpretation of computed splenoportography data.Conclusion. It is reasonable to combine the shunt placement stage of TIPS for variceal bleeding with selective embolization of all radiologically detected inflow pathways to gastroesophageal varices. If the portal vein thrombosis is not accompanied by cavernous transformation, TIPS can achieve effective portal decompression provided the portal blood flow is restored.

show abstract

Section: вве де ниеunclassified