Pros and cons of TIPS for refractory ascites

Sanyal, A.

doi:10.1016/j.jhep.2005.09.006

Cited by 11 publications

(5 citation statements)

References 11 publications

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“…Malnutrition is associated with impaired immunity and increased susceptibility to infection in patients hospitalized for cirrhosis and ascites, 22,23 and it has been shown to correlate with poor hepatic function and severity of disease in cirrhotic‐patients 24 . Many of the complications associated with chronic liver disease (ascites, encephalopathy and sepsis) occur in conjunction with a negative nitrogen state 25–28 . Theoretically, the objective of nutritional‐support in patients with liver failure is to provide adequate nutrients, thereby ensuring the availability of specific substrates for energy/protein synthesis and for normal hepatocyte survival and function.…”

Section: Discussionmentioning

confidence: 99%

“…24 Many of the complications associated with chronic liver disease (ascites, encephalopathy and sepsis) occur in conjunction with a negative nitrogen state. [25][26][27][28] Theoretically, the objective of nutritional-support in patients with liver failure is to provide adequate nutrients, thereby ensuring the availability of specific substrates for energy/protein synthesis and for normal hepatocyte survival and function. However, whether nutritional-support improves the survival of patients with cirrhosis and RA is still debatable.…”

Section: Discussionmentioning

confidence: 99%

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Preservation of nutritional‐status in patients with refractory ascites due to hepatic cirrhosis who are undergoing repeated paracentesis

Sorrentino

Castaldo

Tarantino

et al. 2012

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preservation of nutritional‐status in patients with refractory ascites due to hepatic cirrhosis who are undergoing repeated paracentesis

Sorrentino

Castaldo

Tarantino

et al. 2012

J of Gastro and Hepatol

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“…Also, the careful selection of candidates for TIPS among patients with cirrhosis and refractory ascites improves the results of the operation. The adverse outcome after TIPS is found in CTP class C patients[97] with the following: (1) MELD score > 25 points and a portosystemic gradient < 8 mmHg[98]; (2) INR value > 2[99]; (3) Total serum bilirubin level > 3 mg/dL and platelet count < 75 × 10 9 /L[100]; (4) Serum creatinine level > 1.9 mg/dL[101]; (5) Glomerular filtration rate < 90 mL/min and platelet count < 125 × 10 9 /L[102]; (6) Recurrent hepatic encephalopathy, which equals or exceeds the 2 nd stage[103]; and (7) Diastolic dysfunction (E/A ratio ≤ 1)[104].…”

Section: Treatment Of Ascites In Patients With Cirrhosismentioning

confidence: 99%

Current approaches to the management of patients with cirrhotic ascites

Garbuzenko¹,

Arefyev²

2019

WJG

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This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 1991-2018 using the keywords: “liver cirrhosis,” “portal hypertension,” “ascites,” “pathogenesis,” “diagnostics,” and “treatment.” Uncomplicated and refractory ascites in patients with cirrhosis were the inclusion criteria. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients.

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“…Transjugular intrahepatic portosystemic shunt (TIPS) is a highly effective standard procedure to reduce the portosystemic pressure gradient in patients suffering from complications of portal hypertension such as ascites and variceal bleeding [1][2][3][4][5][6][7]. The most challenging and a time-consuming steps during the TIPS procedures are the catheterization of the appropriate hepatic vein and the puncture of the portal vein under fluoroscopic guidance.…”

Section: Introductionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt placement: portal vein puncture guided by 3D/2D image registration of contrast-enhanced multi-detector computed tomography and fluoroscopy

et al. 2020

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Background To assess the technical feasibility, success rate, puncture complications and procedural characteristics of transjugular intrahepatic portosystemic shunt (TIPS) placement using a three-dimensional vascular map (3D-VM) overlay based on image registration of pre-procedural contrast-enhanced (CE) multi-detector computed tomography (MDCT) for portal vein puncture guidance. Materials and methods Overall, 27 consecutive patients (59 ± 9 years, 18male) with portal hypertension undergoing elective TIPS procedure were included. TIPS was guided by CE-MDCT overlay after image registration based on fluoroscopic images. A 3D-VM of the hepatic veins and the portal vein was created based on the pre-procedural CE-MDCT and superimposed on fluoroscopy in real-time. Procedural characteristics as well as hepatic vein catheterization time (HVCT), puncture time (PT), overall procedural time (OPT), fluoroscopy time (FT) and the dose area product (DAP) were evaluated. Thereafter, HVCT, PT, OPT and FT using 3D-VM (61 ± 9 years, 14male) were compared to a previous using classical fluoroscopic guidance (53 ± 9 years, 21male) for two interventional radiologist with less than 3 years of experience in TIPS placement. Results All TIPS procedure using of 3D/2D image registered 3D-VM were successful with a significant reduction of the PSG (p < 0.0001). No clinical significant complication occurred. HVCT was 14 ± 11 min, PT was 14 ± 6 min, OPT was 64 ± 29 min, FT was 21 ± 12 min and DAP was 107.48 ± 93.84 Gy cm2. HVCT, OPT and FT of the interventionalist with less TIPS experience using 3D/2D image registered 3D-VM were statistically different to an interventionalist with similar experience using fluoroscopic guidance (pHVCT = 0.0022; pOPT = 0.0097; pFT = 0.0009). PT between these interventionalists was not significantly different (pPT = 0.2905). Conclusion TIPS placement applying registration-based CE-MDCT vessel information for puncture guidance is feasible and safe. It has the potential to improve hepatic vein catherization, portal vein puncture and radiation exposure.

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Pros and cons of TIPS for refractory ascites

Cited by 11 publications

References 11 publications

Preservation of nutritional‐status in patients with refractory ascites due to hepatic cirrhosis who are undergoing repeated paracentesis

Preservation of nutritional‐status in patients with refractory ascites due to hepatic cirrhosis who are undergoing repeated paracentesis

Current approaches to the management of patients with cirrhotic ascites

Transjugular intrahepatic portosystemic shunt placement: portal vein puncture guided by 3D/2D image registration of contrast-enhanced multi-detector computed tomography and fluoroscopy

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