Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Krajina, Antonı́n; Hůlek, P; Fejfar, Tomáš; Válek, Vlastimil

doi:10.1007/s00270-012-0493-y

Cited by 74 publications

(71 citation statements)

References 24 publications

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“…Comment: Before TIPS placement, a vascular and anatomical study of the liver should be performed in order to assess both technical feasibility and anatomical contraindications to the creation of the shunt. To this end, there is no evidence to support the use of CT or MR rather than Doppler US [22,24,25].…”

Section: Statement 12 Doppler Ultrasonography (Doppler-us) and Crossmentioning

confidence: 99%

“…by computed tomography (CT) or magnetic resonance (MR) are appropriate to identify anomalies in liver anatomy, to rule out intrahepatic masses, to assess both portal and hepatic vein anatomy and patency and to plan the procedural approach (5, D) [22,24,25]. Votation 1.2: Votes in Favour: 100%.…”

Section: Statement 12 Doppler Ultrasonography (Doppler-us) and Crossmentioning

confidence: 99%

“…These conditions make it difficult to define the ideal dosages of drugs in cirrhotic patients. To avoid respiratory depression and to reduce their hemodynamic impact, anaesthetic and analgesic drugs used during TIPS placement should be easily titratable and/or rapidly antagonized [22,40]. The anaesthetist, depending on the type, will define the frequency of monitoring and its invasiveness and amount of medication administered, the length of the procedure, and the general condition of the patient.…”

Section: Which Types Of Device Are Available For Tips?mentioning

confidence: 99%

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Consensus conference on TIPS management: Techniques, indications, contraindications

Fagiuoli

Bruno

Venon

et al. 2017

Digestive and Liver Disease

127

120

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a b s t r a c tThe trans jugular intrahepatic Porto systemic shunt (TIPS) is no longer viewed as a salvage therapy or a bridge to liver transplantation and is currently indicated for a number of conditions related to portal hypertension with positive results in survival. Moreover, the availability of self-expandable polytetrafluoroethylene (PTFE)-covered endoprostheses has dramatically improved the long-term patency of TIPS. However, since the last updated International guidelines have been published (year 2009) new evidence have come, which have open the field to new indications and solved areas of uncertainty. On this basis, the Italian Association of the Study of the Liver (AISF), the Italian College of Interventional Radiology-Italian Society of Medical Radiology (ICIR-SIRM), and the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI) promoted a Consensus Conference on TIPS. Under the auspices of the three scientific societies, the consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Bergamo on June 4th and 5th, 2015. The final statements presented here were graded according to quality of evidence and strength of recommendations and were approved by an independent jury. By highlighting strengths and weaknesses of current indications to TIPS, the recommendations of AISF-ICIR-SIRM-SIAARTI may represent the starting point for further studies.

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Section: Statement 12 Doppler Ultrasonography (Doppler-us) and Crossmentioning

confidence: 99%

Section: Statement 12 Doppler Ultrasonography (Doppler-us) and Crossmentioning

confidence: 99%

Section: Which Types Of Device Are Available For Tips?mentioning

confidence: 99%

See 1 more Smart Citation

Consensus conference on TIPS management: Techniques, indications, contraindications

Fagiuoli

Bruno

Venon

et al. 2017

Digestive and Liver Disease

127

120

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“…Patients with severe pulmonary hypertension(mean pulmonary artery pressure >45 mmHg) or known cardiac dysfunction such as congestive cardiac failure and severe tricuspid regurgitation [3] , severely impaired liver fuction (e.g. total bilirubin above 5mg/dL, INR>2.0,current HE grade 2 or chronic HE), concomitant active infection, progressive renal failure or other hematological diseases leading to thrombocytopenia were considered unfit for this treatment [13] . After receiving TIPS, all patients were given prophylactic low molecular weight heparin 4,100 IU (GSK China investment co., LTD) Qd or Q12h subcutaneously for 5-7 days, thereafter all patients were orally given aspirin (Bayer Schering Pharma AG) 100 mg Qd or clopidogrel (Sanofi Pharma Bristol-Myers Squibb SNC) 75 mg Qd to prevent blockage of the shunt by thrombus.…”

Section: Therapeutic Protocolmentioning

confidence: 99%

Simultaneous Combined Transjugular Intrahepatic Portosystemic Shunt and Partial Splenic Embolization for Decompensated Cirrhosis

Wan

Yang

et al. 2016

Journal of Gastroenterology and Hepatology Research

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AIM:To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in combination with partial splenic arterial embolization (PSE) for cirrhotic patients with recurrent variceal bleeding and hypersplenism. METHODS: Institutional review board approval was obtained; all patients provided informed consent. From January 2010 to December 2014, a total of 141 cirrhotic patients received TIPS alone(group A, n=114) and simultaneous combined TIPS and PSE(group B, n=27) for recurrent variceal bleeding and hypersplenism secondary to portal hypertension. The TIPS was created by using covered stents. All patients underwent embolotherapy via the jugular vein after TIPS implantation. Patients in group B (n=27) received simultaneous PSE after creation of TIPS. Biochemical tests, coagulation function, complete blood cell (CBC) counts, frequencies of recurrent variceal bleeding and hepatic encephalopathy (HE), and survival were evaluated. Model for end stage liver diseases (MELD) scores were calculated. RESULTS: TIPS creation was successful in all patients. After the treatments, patients in group B had better hepatic synthetic function, increased levels of white blood cells (WBC), platelets (PLT), and hemoglobin(HGB), lower frequency of HE, lower overall and cirrhosis-related mortality than patients in group A (P<0.05), though the two groups had similar recurrent variceal bleeding frequency (P>0.05). Multivariate analysis showed that MELD scores, HE, and group were independent factors for overall and liver-related mortality at month 24 (P<0.05). No severe complications were observed in the two groups. CONCLUSIONS: Simultaneous combined TIPS and PSE regimen improves hematologic parameters, prevents deterioration of liver function and coagulation function, reduces variceal bleeding and HE, thus reduces mortality.

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“…Direct intrahepatic portosystemic shunt (DIPS), performed under intravascular or transabdominal US-guidance and fl uoroscopy, has been developed as a modifi ed transjugular intrahepatic portosystemic shunt (TIPS) technique in the case of complete hepatic veins thrombosis [1,2]. These procedures are associated with a high reintervention rate due to stent thrombosis [3] which can be managed by endovascular means.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous rheolytic mechanical thrombectomy in thrombosed direct intrahepatic portosystemic shunt: Report of two cases

Tsetis

Kehagias

Samonakis

et al. 2015

IMAS

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Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Cited by 74 publications

References 24 publications

Consensus conference on TIPS management: Techniques, indications, contraindications

Consensus conference on TIPS management: Techniques, indications, contraindications

Simultaneous Combined Transjugular Intrahepatic Portosystemic Shunt and Partial Splenic Embolization for Decompensated Cirrhosis

Percutaneous rheolytic mechanical thrombectomy in thrombosed direct intrahepatic portosystemic shunt: Report of two cases

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