Emergent Transjugular Intrahepatic Portosystemic Shunt Creation in Acute Variceal Bleeding

Pandhi, Mithil B.; Kuei, Andrew; Lipnik, Andrew J.; Gaba, Ron C.

doi:10.1055/s-0039-3402015

Cited by 4 publications

(5 citation statements)

References 149 publications

(164 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Treatment of acute variceal bleeding requires a multidisciplinary approach which includes pharmacologic, endoscopic, and interventional therapies. 1 If bleeding cannot be medically controlled, patients may be referred to Interventional Radiology for TIPS creation. Early TIPS placement has been shown to reduce treatment failure and mortality in patients with cirrhosis and acute variceal bleeding.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Viatorr Stent Migration and Retrieval during Transjugular Intrahepatic Portosystemic Shunt Revision

Kim

Samuel

Makramalla

2023

Semin intervent Radiol

View full text Add to dashboard Cite

Transjugular intrahepatic portosystemic shunt (TIPS) is an important interventional option for the treatment of complications related to cirrhosis and portal hypertension. Emergent TIPS placement can be a life-saving measure in patients with uncontrolled variceal hemorrhage. After TIPS placement, patients may benefit from additional interventions for clinical optimization including stent dilation, stent extension, and embolization of varices. Here, we describe a case of emergent TIPS placement and revision which resulted in TIPS stent migration requiring stent removal and replacement. We discuss our technique and review previously reported methods for the management of migrated TIPS stents.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Computed tomography (CT) angiography demonstrated gastroesophageal varices and a stomach distended with hyperdense fluid concerning for blood (►Fig. 1). Massive transfusion protocol and pressors were initiated.…”

Section: Case Presentationmentioning

confidence: 99%

Viatorr Stent Migration and Retrieval during Transjugular Intrahepatic Portosystemic Shunt Revision

Kim

Samuel

Makramalla

2023

Semin intervent Radiol

View full text Add to dashboard Cite

show abstract

“…Например, возможно ли ее неотложное проведение при безуспешности мер медикаментозного и эндоскопического гемостаза и продолжающемся кровотечении? Ряд специалистов утверждают, что не только возможно, но даже необходимо применять "раннее" TIPS [11,12]. Оправдано ли осуществление TIPS в ситуации, когда пищеводно-желудочные вариксы (ПЖВ) при эндоскопическом исследовании выглядят угрожающе, а ВПЖК в анамнезе у пациента еще не было?…”

Section: вве де ниеunclassified

“…Для эмболизации путей притока к ПЖВ предпочтение отдавали эмболизирующим спиралям модели MReye ® (Cook, США), поскольку их длинные волокна обеспечивают хорошую тромбогенность. Число спиралей, применяемых во время операции, зависело от выявленных путей притока, их диаметра и характера ветвления, в среднем составило 4,7 ± 2,9 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Section: материал и методыunclassified

Selection of a portosystemic shunt placement procedure (TIPS) in the treatment of complicated portal hypertension

et al. 2022

View full text Add to dashboard Cite

Aim. To improve treatment results in patients with the life-threatening complications of cirrhotic portal hypertension by making an informed choice of the optimal TIPS (transjugular intrahepatic portosystemic shunt) variant.Materials and methods. A total of 234 patients suffering from the complications of cirrhotic portal hypertension underwent TIPS placement. The indications for shunt placement include esophageal and gastric varices exhibiting the signs of bleeding or carrying the risk of rebleeding (in 172 patients), refractory ascites (in 57 patients), and portal vein thrombosis in the setting of cirrhosis (in 5 patients). Patients from Group 1 underwent shunt placement together with the embolization of inflow pathways to esophageal and gastric varices. In Group 2, priority was given to perioperative therapy, while shunt placement was used together with embolization only in cases of severe varices. In Group 3, the shunt placement stage was combined with the portal blood flow restoration. Immediate and late results were studied in terms of complications, as well as mortality rate and survival rates.Results. The maximum observation duration amounted to 140 months (11.7 years). TIPS efficacy in all patients was confirmed by a statistically significant decrease in the portosystemic pressure gradient. In Group 1, the highest mortality rate associated with rebleeding was observed in patients who had undergone only shunt placement (30.6%), while the lowest rate was noted in patients whose inflow pathways to varices had first been embolized and who then had undergone intrahepatic shunt placement (7.1%). Patients in Group 2 exhibited a reduction in ascites and the severity of varices. The technical feasibility of TIPS in the setting of portal vein thrombosis was enhanced by experience accumulation and preoperative planning relying on careful interpretation of computed splenoportography data.Conclusion. It is reasonable to combine the shunt placement stage of TIPS for variceal bleeding with selective embolization of all radiologically detected inflow pathways to gastroesophageal varices. If the portal vein thrombosis is not accompanied by cavernous transformation, TIPS can achieve effective portal decompression provided the portal blood flow is restored.

show abstract

“…Current risk stratification of patients who have refractory variceal bleeding and require sTIPS is however imperfect. Although TIPS is a minimally invasive procedure, appropriate patient selection is crucial to identify patients who would benefit from the procedure, considering the substantial risks of hepatic encephalopathy, liver failure and increased overall morbidity and mortality in high-risk individuals[ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Novel CABIN score outperforms other prognostic models in predicting in-hospital mortality after salvage transjugular intrahepatic portosystemic shunting

Krige¹,

Jonas²,

Robinson³

et al. 2023

World J Gastrointest Pathophysiol

View full text Add to dashboard Cite

BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is now established as the salvage procedure of choice in patients who have uncontrolled or severe recurrent variceal bleeding despite optimal medical and endoscopic treatment. AIM To analysis compared the performance of eight risk scores to predict in-hospital mortality after salvage TIPS (sTIPS) placement in patients with uncontrolled variceal bleeding after failed medical treatment and endoscopic intervention. METHODS Baseline risk scores for the Acute Physiology and Chronic Health Evaluation (APACHE) II, Bonn TIPS early mortality (BOTEM), Child-Pugh, Emory, FIPS, model for end-stage liver disease (MELD), MELD-Na, and a novel 5 category CABIN score incorporating Creatinine, Albumin, Bilirubin, INR and Na, were calculated before sTIPS. Concordance (C) statistics for predictive accuracy of in-hospital mortality of the eight scores were compared using area under the receiver operating characteristic curve (AUROC) analysis. RESULTS Thirty-four patients (29 men, 5 women), median age 52 years (range 31-80) received sTIPS for uncontrolled (11) or refractory (23) bleeding between August 1991 and November 2020. Salvage TIPS controlled bleeding in 32 (94%) patients with recurrence in one. Ten (29%) patients died in hospital. All scoring systems had a significant association with in-hospital mortality ( P < 0.05) on multivariate analysis. Based on in-hospital survival AUROC, the CABIN (0.967), APACHE II (0.948) and Emory (0.942) scores had the best capability predicting mortality compared to FIPS (0.892), BOTEM (0.877), MELD Na (0.865), Child-Pugh (0.802) and MELD (0.792). CONCLUSION The novel CABIN score had the best prediction capability with statistical superiority over seven other risk scores. Despite sTIPS, hospital mortality remains high and can be predicted by CABIN category B or C or CABIN scores > 10. Survival was 100% in CABIN A patients while mortality was 75% for CABIN B, 87.5% for CABIN C, and 83% for CABIN scores > 10.

show abstract

Emergent Transjugular Intrahepatic Portosystemic Shunt Creation in Acute Variceal Bleeding

Cited by 4 publications

References 149 publications

Viatorr Stent Migration and Retrieval during Transjugular Intrahepatic Portosystemic Shunt Revision

Viatorr Stent Migration and Retrieval during Transjugular Intrahepatic Portosystemic Shunt Revision

Selection of a portosystemic shunt placement procedure (TIPS) in the treatment of complicated portal hypertension

Novel CABIN score outperforms other prognostic models in predicting in-hospital mortality after salvage transjugular intrahepatic portosystemic shunting

Contact Info

Product

Resources

About