The role of Transjugular Intrahepatic Portosystemic Stent‐Shunt (<scp>TIPSS</scp>) in the management of variceal hemorrhage

Corbett, Chris; Mangat, K.; Olliff, Simon; Tripathi, Dhiraj

doi:10.1111/j.1478-3231.2012.02861.x

Cited by 20 publications

(20 citation statements)

References 93 publications

(99 reference statements)

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“…This is unexpected because greater patency results in increased portosystemic shunting and, therefore, greater anticipated encephalopathy. The same finding was reported in a randomized controlled study of TIPS 29. The reason is not clear, but it might be related to the need for fewer interventions for shunt insufficiency compared with bare stents 29.…”

Section: Discussionsupporting

confidence: 58%

“…The same finding was reported in a randomized controlled study of TIPS 29. The reason is not clear, but it might be related to the need for fewer interventions for shunt insufficiency compared with bare stents 29. Another potential reason could be improved control of ascites and congestion of the bowel wall with decreased bacterial translocation or even overt bacteremia 30.…”

Section: Discussionmentioning

confidence: 67%

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Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data

Kim

Chung

et al. 2014

Clin Mol Hepatol

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Background/AimsThis retrospective study assessed the clinical outcome of a transjugular intrahepatic portosystemic shunt (TIPS) procedure for managing portal hypertension in Koreans with liver cirrhosis.MethodsBetween January 2003 and July 2013, 230 patients received a TIPS in 13 university-based hospitals.ResultsOf the 229 (99.6%) patients who successfully underwent TIPS placement, 142 received a TIPS for variceal bleeding, 84 for refractory ascites, and 3 for other indications. The follow-up period was 24.9±30.2 months (mean±SD), 74.7% of the stents were covered, and the primary patency rate at the 1-year follow-up was 78.7%. Hemorrhage occurred in 30 (21.1%) patients during follow-up; of these, 28 (93.3%) cases of rebleeding were associated with stent dysfunction. Fifty-four (23.6%) patients developed new hepatic encephalopathy, and most of these patients were successfully managed conservatively. The cumulative survival rates at 1, 6, 12, and 24 months were 87.5%, 75.0%, 66.8%, and 57.5%, respectively. A high Model for End-Stage Liver Disease (MELD) score was significantly associated with the risk of death within the first month after receiving a TIPS (P=0.018). Old age (P<0.001), indication for a TIPS (ascites vs. bleeding, P=0.005), low serum albumin (P<0.001), and high MELD score (P=0.006) were associated with overall mortality.ConclusionsA high MELD score was found to be significantly associated with early and overall mortality rate in TIPS patients. Determining the appropriate indication is warranted to improve survival in these patients.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 67%

Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data

Kim

Chung

et al. 2014

Clin Mol Hepatol

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“…With the development of covered stents, the frequency of TIPS dysfunctions has been reduced [17]. However, the incidence of hyperplastic stenosis is still one of TIPS’ main shortcomings [18].…”

Section: Discussionmentioning

confidence: 99%

Portacaval Shunt Established in Six Dogs Using Magnetic Compression Technique

Yan

Fan

et al. 2013

PLoS ONE

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Background and AimsInstalling the transjugular intrahepatic portosystemic shunt for portal hypertension is relatively safe, but complications are still high. To explore a new method of portacaval shunt, the magnetic compression technique was introduced into the shunting procedure.MethodsA portal-inferior vena cava shunt was performed on 6 male mongrel dogs by two hemocompatible Nd-Fe-B permanent magnets, parent and daughter. The parent magnet was applied to the inferior vena cava guided by a catheter through the femoral vein. The daughter magnet was moved to the anastomosis position on the portal vein with a balloon catheter through the splenic vein. After the daughter magnet reached the target position, the two magnets acted to compress the vessel wall and hold it in place. Five to 7 days later, under X-ray guidance, the magnets were detached from the vessel wall with a rosch-uchida transjugular liver access set. One month later, histological analysis and portal venography were performed.Results5-7 days after the first surgery, a mild intimal hyperplasia in the portal vein and the inferior vena cava, and continuity of the vascular adventitia from the portal vein to the inferior vena cava as observed. During the second surgery, the contrast media could be observed flowing from the portal vein into the inferior vena cava. Portal venography revealed that the portosystemic shunt was still present one month after the second surgery.ConclusionsMagnamosis via a device of novel design was successfully used to establish a portacaval shunt in dogs.

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“…In case of treatment failure or with recurrent bleeding, TIPS may be considered as a rescue therapy with success rate of up to 90% [2,4]. TIPS significantly reduces the risk of rebleeding, but it is associated with higher prevalence of hepatic encephalopathy in comparison to medical or endoscopic treatment [4,5]. …”

Section: Introductionmentioning

confidence: 99%

CT-assisted transfemoral intrahepatic portosystemic shunt in a long duration follow-up: A case report

et al. 2014

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SummaryBackgroundTransjugular intrahepatic portosystemic shunt (TIPS) in patients with portal hypertension may be considered as a rescue therapy in case of recurrent variceal bleeding or failure of endoscopic management.Case ReportsWe present a case of a patient with massive gastroesophageal variceal bleeding refractory to numerous endoscopic treatments in which TIPS was considered in an attempt to decrease the risk of potentially fatal rebleeding. Standard TIPS procedure was not feasible due to altered anatomy of the liver resulting from right hemidiaphragmatic paresis. Computed Tomography (CT) fluoroscopic guidance was utilized for direct percutaneous puncture of the left hepatic and left portal vein with subsequent guidewire snaring to perform portosystemic shunting via femoral access. Since the procedure, no recurrent variceal bleeding was reported and the shunt remained patent at a 3-year follow-up. Although stent fracture with fragment migration was observed.ConclusionsSignificant variation in liver anatomy does not preclude the creation of nonsurgical portosystemic shunt. In these cases, combined percutaneous and endovascular technique may be utilized.

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The role of Transjugular Intrahepatic Portosystemic Stent‐Shunt (TIPSS) in the management of variceal hemorrhage

Abstract: Background: Variceal bleeding in

Cited by 20 publications

References 93 publications

Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data

Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension: Korean multicenter real-practice data

Portacaval Shunt Established in Six Dogs Using Magnetic Compression Technique

CT-assisted transfemoral intrahepatic portosystemic shunt in a long duration follow-up: A case report

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