Trans jugular Intrahepatic Portosystemic Shunt

Buuren, Henk R. van; Cheng, KF; Pieterman, H.; Schalm, S. W.; Laméris, Johan S.

doi:10.3109/00365529309101575

Cited by 8 publications

(1 citation statement)

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“…4 Portal biliopathy is a dreaded complication of EHO where in there is obstructive biliopathy from portal cavernoma and ischemic changes in bile ducts and can only be palliated to some extent with shunt surgery. 5,6 Lack of shuntable veins due to splenic vein thrombosis precludes possibility of linorenal shunt in some EHO patients.TIPS or trans jugular portosystemic shunt is a radiological procedure but needs frequent reintervention in order to prolong shunt patency 7 and largely used for temporary respite from bleeding and ascites and buy time till transplant is arranged.Thus, it is not advisable in NCPF patients because they will live near normal lifespan without need for transplant. Shunt surgery provides them one time and permanent solution.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Portal Hypertension: Experience at a Medical College Hospital in South India

Kulkarni¹

2020

IJCMR

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Introduction: Portal hypertension in the presence of cirrhosis of liver carries poor prognosis. The medical management along with endoscopic therapy helps to reduce bleeding. Surgery is reserved for patients who fail medical therapy. Patients with portal hypertension with good functioning liver benefit from surgery. Study aimed to evaluate the results of surgical treatment for portal hypertension at our center Karnataka Institute of Medical Sciences Hubli. Karnataka. Material and methods. This was a prospective observational study. There were 34 patients undergoing surgical treatment for various presentations of portal hypertension during the period of 2015 to 2019.They were analyzed for demographics, etiology, presentation, various surgeries and outcome. The data was entered intoMicrosoft excel sheet and analyzed. Results: Of the 34 patients males were most common. Variceal bleeding was most common presentation followed by painful splenomegaly and anemia. 'Extrahepatic portal vein obstruction' was the leading cause of non-cirrhotic portal hypertension followed by 'non cirrhotic portal fibrosis' and 'left sided or sinistral portal hypertension'. Proximal linorenal shunt was the most common procedure followed by splenectomy with esophagogastric devascularization. The morbidity and mortality were very low and yielded durable satisfactory outcome. Conclusion: The surgery for non-cirrhotic portal hypertension has durable and satisfactory results and can be done with minimal morbidity and mortality at trained hands. For few selected cirrhotic patients surgery in the form of devascularization or shunt offers immediate relief from bleeding and gives time for future transplant if any.

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Section: Discussionmentioning

confidence: 99%

Surgical Management of Portal Hypertension: Experience at a Medical College Hospital in South India

Kulkarni¹

2020

IJCMR

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Decision–Analysis of Transjugular Intrahepatic Portosystemic Shunt Versus Distal Splenorenal Shunt for Portal Hypertension

et al. 1999

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Variceal hemorrhage, a potentially life-threatening complication of portal hypertension caused by cirrhosis, results in 15,000 hospital admissions in the United States annually. 1 In the past, the definitive management of portal hypertension has been portal-decompressive surgery. Creating a communication between the hypertensive portal vein or its principal tributaries and the normotensive inferior vena cava or its principal tributaries improves portal pressure and decompresses varices. The distal splenorenal shunt (DSRS) is one such communication that has been studied extensively in Child' s class A cirrhosis. Because of its selective nature, it can decrease portal hypertension while minimizing the risk of portosystemic encephalopathy, an advantage that is not enjoyed by less selective shunts.Transjugular intrahepatic portosystemic shunt (TIPS) is a less invasive, radiologic procedure in which a shunt is created in the hepatic parenchyma between the portal and hepatic veins. TIPS is analogous to a side-to-side surgical portocaval shunt but avoids the risk of surgery. Since the first successes were reported by Colapinto et al., 2 TIPS has become a frequently used alternative to surgery in the management of variceal bleeding that is unresponsive to conventional medical and endoscopic therapy. It also has been used for the secondary prophylaxis of variceal bleeding and for refractory ascites. 3 TIPS is preferred to surgery in patients with reduced life expectancy and in whom shunt surgery is risky, as in Child' s class C cirrhosis. TIPS has also been used in patients with longer life expectancy, such as in Child' s class A cirrhosis patients. However, the use of TIPS in patients with longer life expectancy has been called into question because of high rates of stent dysfunction (occlusion, thrombosis, or stenosis) ranging from 33% to 66% within the first 12 months of placement. [3][4][5][6][7] In patients with long survival, the surgical shunt might be preferable, but this has not been evaluated in a systematic fashion.The aim of our study was to investigate the effectiveness and costs of TIPS compared with DSRS in Child' s class A cirrhosis using a deterministic decision analysis model. We developed the model to examine the main effects of mortality from each procedure and stent dysfunction for TIPS. PATIENTS AND METHODSWe constructed a decision analysis model to compare outcomes over 2 years for a patient with Child' s class A cirrhosis undergoing either a DSRS or TIPS. Events of interest were procedure death, dysfunction of TIPS, dysfunction of DSRS, and death from liver disease in each year of the model. In the model, dysfunction of TIPS was defined as any abnormality detected by Doppler ultrasound that would lead to a revision of the TIPS, whether this was stenosis, occlusion, or thrombosis. 4 We defined DSRS dysfunction as thrombosis detected on scheduled angiography 1 week after DSRS surgery. Because of the lack of comparative data, we chose not to evaluate the outcomes of encephalopathy and bleeding. We pe...

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The transjugular intrahepatic portosystemic shunt

Rössle¹

1996

Journal of Hepatology

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Trans jugular Intrahepatic Portosystemic Shunt

Cited by 8 publications

References 20 publications

Surgical Management of Portal Hypertension: Experience at a Medical College Hospital in South India

Surgical Management of Portal Hypertension: Experience at a Medical College Hospital in South India

Decision–Analysis of Transjugular Intrahepatic Portosystemic Shunt Versus Distal Splenorenal Shunt for Portal Hypertension

The transjugular intrahepatic portosystemic shunt

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