Portal Venous Interventions: How to Recognize, Avoid, or Get Out of Trouble in Transjugular Intrahepatic Portosystemic Shunt (TIPS), Balloon Occlusion Sclerosis (ie, BRTO), and Portal Vein Embolization (PVE)

Downing, Trevor; Khan, Sarah; Zvavanjanja, Rodrick C.; Bhatti, Zabeer; Pillai, Anil K.; Kee, Stephen T.

doi:10.1053/j.tvir.2018.07.009

Cited by 11 publications

(7 citation statements)

References 90 publications

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“…Over decades of performing TIPS, hemorrhagic complications such as capsular rupture, arterial injury, extrahepatic needle passes, and portal venous lacerations have been described resulting in massive hemoperitoneum and possible death. [7][8][9] Although extrahepatic portal venous punctures or tears are seen in only 0.5% of cases, the higher portal venous pressures lead to rapid exsanguination into the lower pressure abdominal cavity and immediate intervention is required to avoid death. [10][11][12] In the setting of PVT, TIPS carries a moderate risk for major complications of 10%, with the most significant being bleeding.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Portal Venous Circulatory Injuries in the IR Suite

Arleo

Kokabi

Cristescu

et al. 2022

Semin intervent Radiol

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Section: Discussionmentioning

confidence: 99%

Iatrogenic Portal Venous Circulatory Injuries in the IR Suite

Arleo

Kokabi

Cristescu

et al. 2022

Semin intervent Radiol

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“…Therefore, appropriate concentration of cyanoacrylate was relatively important. In previous studies, a mixture of cyanoacrylates and lipiodol with a ratio of 1:1 or 1:2 was frequently used [31]; therefore, a 50% concentration of cyanoacrylate was chosen in the current study. Unfortunately, even though the drainage vein was occluded when cyanoacrylate was injected into GVs, migration of cyanoacrylate into the pulmonary artery occurred in one case.…”

Section: Discussionmentioning

confidence: 99%

Balloon-Assisted Percutaneous Transhepatic Antegrade Embolization with 2-Octyl Cyanoacrylate for the Treatment of Isolated Gastric Varices with Large Gastrorenal Shunts

Wang

Meng

Huang

et al. 2019

BioMed Research International

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Aims. To evaluate the safety and effectiveness of percutaneous transhepatic antegrade embolization (PTAE) with 2-octyl cyanoacrylate assisted with balloon occlusion of the left renal vein or gastrorenal shunts (GRSs) for the treatment of isolated gastric varices (IGVs) with large GRSs. Methods. Thirty patients with IGVs associated with large GRSs who had underwent PTAE assisted with a balloon to block the opening of the GRS in the left renal vein were retrospectively evaluated and followed up. Clinical and laboratory data were collected to evaluate the technical success of the procedure, complications, changes in the liver function using Child-Pugh scores, worsening of the esophageal varices, the rebleeding rate, and survival. Laboratory data obtained before and after PTAE were compared (paired-sample t-test). Results. PTAE was technically successful in all 30 patients. No serious complications were observed except for one nonsymptomatic pulmonary embolism. During a mean follow-up of 30 months, rebleeding was observed in 4/30 (13.3%) patients, worsening of esophageal varices was observed in 4/30 (13.3%) patients, and newly developed or aggravated ascites were observed on CT in 3/30 (10%) patients. Significant improvement was observed in Child-Pugh scores (p=0.009) and the international normalized ratio (INR) (p=0.004) at 3 months after PTAE. The cumulative survival rates at 1, 2, 3, and 5 years were 96.3%, 96.3%, 79.9%, and 79.9%, respectively. Conclusion. Balloon-assisted PTAE with 2-octyl cyanoacrylate is technically feasible, safe, and effective for the treatment of IGV associated with a large GRS.

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“…Technical aspects of this procedure have been extensively described in prior studies. 105 , 106 Overall, the reported technical success has been reported to be between 80–100%. 107 Briefly, PVE can be performed by a percutaneous transhepatic contralateral approach with ultrasound-guided access to the portal vein via the FLR, a transhepatic ipsilateral approach via the future resected liver, or a trans-ileocolic venous approach.…”

Section: Portal Vein Embolisationmentioning

confidence: 99%

“… 107 Briefly, PVE can be performed by a percutaneous transhepatic contralateral approach with ultrasound-guided access to the portal vein via the FLR, a transhepatic ipsilateral approach via the future resected liver, or a trans-ileocolic venous approach. 106 The approach depends on the patients’ anatomy and the radiologist’s preference, and in relation to the possible risks of FLR injury with the contralateral approach. Numerous embolic agents can be used.…”

Section: Portal Vein Embolisationmentioning

confidence: 99%