An Algorithm for Management After Transjugular Intrahepatic Portosystemic Shunt Placement According to Clinical Manifestations

Kim, Seung Kwon; Belikoff, B; Guevara, Carlos J.; Park, Seong Jin

doi:10.1007/s10620-016-4399-4

Cited by 4 publications

(3 citation statements)

References 72 publications

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“…There are many studies showing the benefits of a TIPS in treating PH that is refractory to medical therapy, including in cases of refractory ascites and variceal hemorrhage, and TIPSs have also been shown to improve survival in many settings ( 27 , 28 ). Potential complications of TIPSs include further hepatic decompensation, worsening hepatic encephalopathy, cardiac failure, TIPS dysfunction, and, in rare cases, death, and thus, proper patient selection is required ( 28 , 29 ).…”

Section: Treatment Of Portal Hypertensionmentioning

confidence: 99%

Current and investigational drugs in early clinical development for portal hypertension

2022

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IntroductionThe development of portal hypertension leads to a majority of complications associated with chronic liver disease. Therefore, adequate treatment of portal hypertension is crucial in the management of such patients. Current treatment options are limited and consist mainly of medications that decrease the hyperdynamic circulation, such as non-selective beta blockers, and treatment of hypervolemia with diuretics. Despite these options, mortality rates have not improved over the last two decades. Newer, more effective treatment options are necessary to help improve survival and quality of life in these patients.Areas coveredMultiple preclinical models and clinical studies have demonstrated potential efficacy of a variety of new treatment modalities. We introduce treatment options including the use of vasodilation promotors, vasoconstriction inhibitors, anticoagulants, antiangiogenics, and anti-inflammatory drugs. We examine the most recent studies for treatment options within these drug classes and offer insights as to which show the most promise in this field.MethodologyPublished studies that identified novel medical treatment options of portal hypertension were searched using PubMed (https://pubmed.ncbi.nlm.nih.gov/). Clinical trials listed in Clinicaltrials.gov were also searched with a focus on more recent and ongoing studies, including those with completed recruitment. Searching with key terms including “portal hypertension” as well as individually searching specific treatment medications that were listed in other publications was carried out. Finally, current societal guidelines and recent review articles relevant to the management of portal hypertension were evaluated, and listed references of interest were included.ConclusionMany ongoing early phase studies demonstrate promising results and may shape the field of portal hypertension management in future. As concrete results become available, larger RCTs will be required before making definitive conclusions regarding safety and efficacy and whether or not they can be incorporated into routine clinical practice. Statins, anticoagulants, and PDE inhibitors have been among the most studied and appear to be most promising.

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Section: Treatment Of Portal Hypertensionmentioning

confidence: 99%

Current and investigational drugs in early clinical development for portal hypertension

2022

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“…In-stent stenosis most commonly occurs at the hepatico-caval junction. Multiple studies have shown that angioplasty with the placement of covered stents gives better long term results compared to angioplasty alone[ 248 ]. Restenting is also useful in cases of stent shortening or portal venous stenosis.…”

Section: Update On the Technical Aspects Of Tipsmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update

Rajesh

George

Philips

et al. 2020

WJG

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More than five decades after it was originally conceptualized as rescue therapy for patients with intractable variceal bleeding, the transjugular intrahepatic portosystemic shunt (TIPS) procedure continues to remain a focus of intense clinical and biomedical research. By the impressive reduction in portal pressure achieved by this intervention, coupled with its minimally invasive nature, TIPS has gained increasing acceptance in the treatment of complications of portal hypertension. The early years of TIPS were plagued by poor long-term patency of the stents and increased incidence of hepatic encephalopathy. Moreover, the diversion of portal flow after placement of TIPS often resulted in derangement of hepatic functions, which was occasionally severe. While the incidence of shunt dysfunction has markedly reduced with the advent of covered stents, hepatic encephalopathy and instances of early liver failure continue to remain a significant issue after TIPS. It has emerged over the years that careful selection of patients and diligent post-procedural care is of paramount importance to optimize the outcome after TIPS. The past twenty years have seen multiple studies redefining the role of TIPS in the management of variceal bleeding and refractory ascites while exploring its application in other complications of cirrhosis like hepatic hydrothorax, portal hypertensive gastropathy, ectopic varices, hepatorenal and hepatopulmonary syndromes, non-tumoral portal vein thrombosis and chylous ascites. It has also been utilized to good effect before extrahepatic abdominal surgery to reduce perioperative morbidity and mortality. The current article aims to review the updated literature on the status of TIPS in the management of patients with liver cirrhosis.

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“…After TIPS implantation, laboratory testings (including blood test, liver and kidney function and coagulation function) and imaging examinations (such as ultrasound, CT or MRI) were reexamined at 1, 3, 6, 12 months in the rst year and once a year here after. Phone calls were made regularly to keep up with the prognosis and complications of the patients and they were kept in detailed records [21].…”

Section: Follow Upmentioning

confidence: 99%

A New Choice for the Use of the Stents for Transjugular Intrahepatic Portosystemic Shunt Creation: Viabahn ePTFE covered stent/bare metal stent combination

Liu

Meng

Zhou

et al. 2020

Preprint

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Background Compare the clinical outcome of structure and function between insertion of transjugular intrahepatic portosystemic shunt (TIPS) created with the Viabahn ePTFE covered stent/bare metal stent (BMS) combination and Fluency ePTFE covered stent/BMS combination. Methods 101 consecutive patients undergone TIPS procedure from February 2016 to August 2018 in our center were analyzed retrospectively, 64 subjects were enrolled in Viabahn group and 37 were Fluency group. We caculated the TIPS geometry characteristics and evaluated the related occurrence of shunt dysfunction, survival, overt hepatic encephalopathy (OHE) and variceal rebleeding. Results The technical success rate was 100%. After TIPS insertion, the rate of shunt dysfunction during the first 3 months was significantly different between Viabahn group and Fluency group, which were respectively 1.6% and 13.5% (p = 0.024). And multivariate analysis indicated that the angle of portalvenous inflow (α) (HR = 1.060, 95%CI = 1.009–1.112, p = 0.020) was the only predictor of shunt dysfunction. Besides, after 3 months following TIPS insertion, the α angle distinctly increased from 20.9°±14.3° to 26.9°±20.1° (p = 0.005) in Fluency group but stayed unchanged in Viabahn group (from 21.9°±15.1° to 22.9°±17.6°, p = 0.798). Conclusions The occurence of shunt dysfunction was related to the angle of portalvenous inflow (α), because of the slighter effect on α angle, after TIPS inplanation, Viabahn ePTFE covered stent/BMS combination was more stable in structure and promised higher short-term stent patency compared to Fluency ePTFE covered stent/BMS combination.

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An Algorithm for Management After Transjugular Intrahepatic Portosystemic Shunt Placement According to Clinical Manifestations

Cited by 4 publications

References 72 publications

Current and investigational drugs in early clinical development for portal hypertension

Current and investigational drugs in early clinical development for portal hypertension

Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update

A New Choice for the Use of the Stents for Transjugular Intrahepatic Portosystemic Shunt Creation: Viabahn ePTFE covered stent/bare metal stent combination

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