TIPS for refractory ascites: a single-centre experience

Thalheimer, Ulrich; Leandro, Gioacchino; Samonakis, Dimitrios; Triantos, Christos; Senzolo, Marco; Fung, Konrad; Davies, Neil; Patch, David; Burroughs, Andrew K.

doi:10.1007/s00535-009-0099-6

Cited by 35 publications

(34 citation statements)

References 15 publications

(28 reference statements)

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“…Comment: Two RCTS [32,33] and a meta-analysis [29] of six studies (one prospective and five retrospective) comparing TIPS placement with PTFE-covered stents and bare stents for portal hypertension related complications showed that the covered stent was superior in terms of shunt dysfunction (HR = 0.28; 95% CI 0.20-0.35).…”

Section: Which Types Of Device Are Available For Tips?mentioning

confidence: 99%

“…A step-wise procedure based on the progressive dilation of 10-mm diameter covered stents by using balloon catheters of increasing diameter might be used. The extent of dilation can be considered acceptable when the target PPG is reached (in case of variceal bleeding) (1a, A) [14] or an adequate clinical response is obtained (in case of refractory/recidivant ascites) (4, C) [14,25,31,32]. 1.6b There is not enough evidence to support the use of 10-mm rather than 8-mm nominal diameter PTFE-covered stents aiming to achieve a better control of portal hypertension complications (5, D) [33,34].…”

Section: Which Types Of Device Are Available For Tips?mentioning

confidence: 99%

“…Despite that, most operators perform TIPS using a 10 mm stent dilated to 8 mm (with subsequent calibration up to 10 mm depending on postprocedure portocaval gradient) [3, 33,34]. A step-wise procedure based on the progressive dilatation of 10 mm diameter stents at TIPS positioning or at delayed time points during follow up can be also applied in ascitic patients with the goal to achieve a portal-pressure gradient <12 mmHg [14,25] and or an adequate clinical response [31,32].…”

Section: Which Types Of Device Are Available For Tips?mentioning

confidence: 99%

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Consensus conference on TIPS management: Techniques, indications, contraindications

Fagiuoli

Bruno

Venon

et al. 2017

Digestive and Liver Disease

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130

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a b s t r a c tThe trans jugular intrahepatic Porto systemic shunt (TIPS) is no longer viewed as a salvage therapy or a bridge to liver transplantation and is currently indicated for a number of conditions related to portal hypertension with positive results in survival. Moreover, the availability of self-expandable polytetrafluoroethylene (PTFE)-covered endoprostheses has dramatically improved the long-term patency of TIPS. However, since the last updated International guidelines have been published (year 2009) new evidence have come, which have open the field to new indications and solved areas of uncertainty. On this basis, the Italian Association of the Study of the Liver (AISF), the Italian College of Interventional Radiology-Italian Society of Medical Radiology (ICIR-SIRM), and the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI) promoted a Consensus Conference on TIPS. Under the auspices of the three scientific societies, the consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Bergamo on June 4th and 5th, 2015. The final statements presented here were graded according to quality of evidence and strength of recommendations and were approved by an independent jury. By highlighting strengths and weaknesses of current indications to TIPS, the recommendations of AISF-ICIR-SIRM-SIAARTI may represent the starting point for further studies.

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Section: Which Types Of Device Are Available For Tips?mentioning

confidence: 99%

Section: Which Types Of Device Are Available For Tips?mentioning

confidence: 99%

Section: Which Types Of Device Are Available For Tips?mentioning

confidence: 99%

See 1 more Smart Citation

Consensus conference on TIPS management: Techniques, indications, contraindications

Fagiuoli

Bruno

Venon

et al. 2017

Digestive and Liver Disease

Self Cite

130

120

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“…Several metaanalyses based on RCTs revealed that TIPS is superior in controlling ascites than LVP, although it causes hepatic encephalopathy more frequently [167][168][169][170]. The use of narrow-diameter dilation by TIPS decreased the incidence of severe hepatic encephalopathy [171]. The introduction of a covered stent offers better symptomatic control and overall survival, especially in patients with a MELD score of less than 16 at the baseline [172,173].…”

Section: Cq: Is Albumin Infusion Effective For Treatment Of Cirrhoticmentioning

confidence: 99%

Evidence-based clinical practice guidelines for liver cirrhosis 2015

et al. 2016

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The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V 2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for patients with acute-onset or progressive portal vein thrombosis.

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“…Despite these advances, HE remains a pertinent post-procedural complication as portosystemic shunt physiology can trigger or worsen HE [1,2,8] . New or progressive post-TIPS HE of any severity has been shown to occur in 5%-35% of patients, while severe post-TIPS HE that does not respond to medical management and requires TIPS reduction or occlusion, occurs in up to 7% of patients [3,10,15,16] . Given the potential conflicting relationship between portal decompression and HE, efforts have been made to develop techniques to balance the desired therapeutic effect while minimizing over-shunting [3,17] .…”

Section: Introductionmentioning

confidence: 99%

Passive expansion of submaximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes

Hsu

Weber

Nadolski³

2016

Journal of Vascular and Interventional Radiology

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AIMTo assess for passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts (TIPS) and compare outcomes with maximally dilated TIPS. METHODS Polytetrafluoroethylene covered TIPS (Viatorr) fromJuly 2002 to December 2013 were retrospectively reviewed at two hospitals in a single institution. Two hundred and thirty patients had TIPS maximally dilated to 10 mm (mTIPS), while 43 patients who were at increased risk for hepatic encephalopathy (HE), based on clinical evaluation or low pre-TIPS portosystemic gradient (PSG), had 10 mm TIPS sub-maximally dilated to 8 mm (smTIPS). Hsu MC et al . Passive expansion of sub-maximally dilated TIPS primary assisted patency, and severe post-TIPS HE. A subset of fourteen patients with smTIPS underwent follow-up computed tomography imaging after TIPS creation, and were grouped based on time of imaging (< 6 mo and > 6 mo). Change in diameter and crosssectional area were measured with 3D imaging software to evaluate for passive expansion. RESULTSPatient characteristics were similar between the smTIPS and mTIPS groups, except for pre-TIPS portosystemic gradient, which was lower in the smTIPS group (19.4 mmHg ± 6.8 vs 22.4 mmHg ± 7.1, P = 0.01). Primary patency and primary assisted patency between smTIPS and mTIPS was not significantly different (P = 0.64 and 0.55, respectively). Four of the 55 patients (7%) with smTIPS required TIPS reduction for severe refractory HE, while this occurred in 6 of the 218 patients (3%) with mTIPS (P = 0.12). For the 14 patients with follow-up computed tomography (CT) imaging, the median imaging follow-up was 373 d. There was an increase in median TIPS diameter, median percent diameter change, median area, and median percent area change in patients with CT follow-up greater than 6 mo after TIPS placement compared to follow-up within 6 mo (8.45 mm, 5.58%, 56.04 mm 2 , and 11.48%, respectively, P = 0.01). CONCLUSIONPassive expansion of smTIPS does occur but clinical outcomes of smTIPS and mTIPS were similar. Sub-maximal dilation can prevent complications related to overshunting in select patients. Core tip: Sub-maximal dilation of transjugular intrahepatic portosystemic shunts (TIPS) is a method to reduce the risk of over-shunting and hepatic encephalopathy. The current study is a retrospective review to compare clinical outcomes of sub-maximally dilated TIPS (smTIPS) with maximally dilated TIPS (mTIPS) and assess for passive expansion of smTIPS. The study demonstrated that passive expansion of smTIPS does occur, however shunts may not fully expand and expansion may occur even after 6 mo. Clinical outcomes of smTIPS and mTIPS were similar, suggesting sub-maximal dilation may be an acceptable method to prevent complications related to over-shunting in select patients.Hsu MC, Weber CN, Stavropoulos SW, Clark TW, Trerotola SO, ShlanskyGoldberg RD, Soulen MC, Nadolski GJ. Passive expansion of submaximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes.

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TIPS for refractory ascites: a single-centre experience

Abstract: The results of our study confirm the efficacy of TIPS for refractory ascites. The use of narrow-diameter dilatation without aiming at lowering the PPG below a certain threshold might simplify the procedure and the follow-up for these patients.

Cited by 35 publications

References 15 publications

Consensus conference on TIPS management: Techniques, indications, contraindications

Consensus conference on TIPS management: Techniques, indications, contraindications

Evidence-based clinical practice guidelines for liver cirrhosis 2015

Passive expansion of submaximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes

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