Transjugular intrahepatic portosystemic shunt for the treatment of intractable ascites in a patient with polycystic liver disease

Bahramipour, Phillip; Festa, Steven; Biswal, Rajiv; Wachsberg, Ronald H.

doi:10.1007/s002700010051

Cited by 12 publications

(6 citation statements)

References 6 publications

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“…9 Exclusion of TIPS depends on the degree of hepatic involvement and the perceived increase in the risk of technical complications. Shunts also have also been created successfully in these latter situations in which hepatic neoplasms 18 and cysts 19,20 lie within the proposed shunt path.…”

mentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting

Wallace

Madoff

Ahrar

et al. 2004

Cancer

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BACKGROUNDTransjugular intrahepatic portosystemic shunt (TIPS) placement has emerged as an effective and minimally invasive method of treating portal hypertension and its associated complications. To the authors' knowledge there is limited documentation of its use for percutaneous shunting in patients with hepatic and extrahepatic malignancies. The current study reports the authors' experience with TIPS in the oncology setting.METHODSThirty‐eight patients with cancer underwent TIPS procedures. Nineteen patients had a history of hepatic malignancy. All medical records and imaging studies were reviewed retrospectively. The indication for TIPS, the presence of malignancy, procedural details, complications, survival, and treatment success were assessed.RESULTSPrimary technical success was accomplished in 37 of 38 patients (97%) without technical procedure‐related complications. Hepatic encephalopathy occurred in 15 of 34 patients (44%), with 3 patients requiring shunt reduction. Premature shunt occlusion (< 30 days) occurred in 3 patients (8%). Recurrent hemorrhage occurred in 1 of 19 patients (5%), and ascites and hepatic hydrothorax resolved or improved subjectively in 9 of 12 patients (75%). Shunts traversed malignancy in 9 patients, and varying degrees of portal compromise were encountered in 12 patients (32%). The overall 30‐day and 90‐day survival rates were 84% and 60%, respectively. There was a statistically significant difference in 90‐day survival rates for patients who had ascites and hepatic hydrothorax indications (27%) compared with patients who had variceal and portal gastropathy indications (84%; P = 0.0075). In addition, the 90‐day survival rate was significantly lower in patients who had primary hepatic malignancies (36%) compared with the remainder of the study population (74%; P = 0.0077), and it was significantly lower in patients who had model for end‐stage liver disease (MELD) scores ≥ 12 (P = 0.0020).CONCLUSIONSTIPS was performed safely for patients with cancer without increasing rates of procedure‐related complications. However, some patients subgroups, such at those with malignancy and ascites, primary hepatic malignancy, or MELD scores ≥ 12, had the lowest 90‐day survival rates. Cancer 2004. © 2004 American Cancer Society.

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confidence: 99%

Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting

Wallace

Madoff

Ahrar

et al. 2004

Cancer

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“…In contrast, some authors have questioned this contra‐indication . The use of TIPS for PLD is limited to a few case reports, and has been described as successful . However, complications such as intracystic haemorrhage, spontaneous bacterial peritonitis and encephalopathy have also been reported .…”

Section: Management Of Portal Hypertension In Pldmentioning

confidence: 99%

“…76 The use of TIPS for PLD is limited to a few case reports, and has been described as successful. 76,[78][79][80][81][82] However, complications such as intracystic haemorrhage, spontaneous bacterial peritonitis and encephalopathy have also been reported. 82 The use of a hybrid 2D/3D imaging instruments or intravascular US guidance can be used to increase safety of TIPS placement in the setting of PLD.…”

Section: Restoration Of Flowmentioning

confidence: 99%

Management of portal hypertension and ascites in polycystic liver disease

Bernts

Drenth

Tjwa

2019

Liver International

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Patients suffering from polycystic liver disease may develop Hepatic Venous Outflow Obstruction, Portal Vein Obstruction and/or Inferior Caval Vein Syndrome because of cystic mass effect. This can cause portal hypertension, leading to ascites, variceal haemorrhage or splenomegaly. For this review, we evaluate the evidence to provide clinical guidance for physicians faced with this complication. Diagnosis is made with imaging such as ultrasound, computed tomography or magnetic resonance imaging. Therapy includes conventional therapy with diuretics and paracentesis, and medical therapy using somatostatin analogues. Based on disease phenotype various (non‐)surgical liver‐volume reducing therapies, hepatic or portal venous stenting, transjugular intrahepatic portosystemic shunts and liver transplantation may be considered. Because of complicated anatomy, use of high‐risk interventions and lack of empirical evidence, patients should be treated in expert centres.

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“…Presumably, the distorted hepatic architecture and risk of cyst entry with intraperitoneal hemorrhage make the procedure unfavourable from a technical perspective. However, there have been published case reports of the beneficial role of TIPS in PCLD (22,23). Case reports have also described the temporary use of mesocaval shunts and beta-blockers for refractory ascites and gastrointestinal varices, respectively (18,19).…”

Section: Treatmentmentioning

confidence: 99%

Management of Polycystic Liver Disease

Cheung

Scudamore

Yoshida

2004

Canadian Journal of Gastroenterology

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Polycystic liver disease (PCLD) is characterized by multiple cysts throughout the liver. Patients may develop chronic intractable symptoms that may be debilitating. Others may develop medical complications that necessitate intervention. There is a variety of nonsurgical and surgical treatment options for symptomatic or complicated PCLD, which range from cyst aspiration and fenestration to liver transplantation. Studies have described variable efficacy and morbidity. Currently, there are no guidelines for the management of PCLD patients and the optimal intervention is controversial. This article reviews the pathogenesis, classification and spectrum of treatment options for PCLD.

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Transjugular intrahepatic portosystemic shunt for the treatment of intractable ascites in a patient with polycystic liver disease

Abstract: Though polycystic liver disease (PCLD) has historically been considered a contraindication to TIPS, we present a case where technically successful shunt creation was achieved without the need for modification of the standard TIPS procedure, as was required in a previous report.

Cited by 12 publications

References 6 publications

Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting

Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting

Management of portal hypertension and ascites in polycystic liver disease

Management of Polycystic Liver Disease

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