Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Treatment of Venous Symptomatic Chronic Portal Thrombosis in Non-cirrhotic Patients

Bilbao, J.I.; Elorz, Mariana; Vivas, Isabel; Martínez-Cuesta, Antonio; Bastarrika, Gorka; Benito, Alberto

doi:10.1007/s00270-004-0241-z

Cited by 95 publications

(80 citation statements)

References 20 publications

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“…In 23 of the 28 patients with complete portal vein thrombosis success was achieved in 73% including 6 of 9 patients with cavernomatous transformation. 165 Another study on TIPS performed on 15 patients with cirrhosis and PVT leading to refractory ascites, variceal hemorrhage and refractory pleural effusion showed its success in 75% (3/4) patients with cavernomatous transformation and 10/11 (94%) patients with acute PVT with an overall survival of 87%. It may thus be a treatment option in certain patients.…”

Section: Tipsmentioning

confidence: 99%

“…164 Studies have shown long term patency rates even without anticoagulation in TIPS, hence routine anticoagulant use may not be recommended after TIPS placement except in those patients with prothrombotic states. In a few cases with PVT, TIPS has been shown to be successful 165,166 in treating patients with portal biliopathy and portal vein thrombosis complicating Budd-Chiari syndrome. In 23 of the 28 patients with complete portal vein thrombosis success was achieved in 73% including 6 of 9 patients with cavernomatous transformation.…”

Section: Tipsmentioning

confidence: 99%

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Portal Vein Thrombosis

Chawla

Bodh

2015

Journal of Clinical and Experimental Hepatology

149

147

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Portal vein thrombosis is an important cause of portal hypertension. PVT occurs in association with cirrhosis or as a result of malignant invasion by hepatocellular carcinoma or even in the absence of associated liver disease. With the current research into its genesis, majority now have an underlying prothrombotic state detectable. Endothelial activation and stagnant portal blood flow also contribute to formation of the thrombus. Acute non-cirrhotic PVT, chronic PVT (EHPVO), and portal vein thrombosis in cirrhosis are the three main variants of portal vein thrombosis with varying etiological factors and variability in presentation and management. Procoagulant state should be actively investigated. Anticoagulation is the mainstay of therapy for acute non-cirrhotic PVT, with supporting evidence for its use in cirrhotic population as well. Chronic PVT (EHPVO) on the other hand requires the management of portal hypertension as such and with role for anticoagulation in the setting of underlying prothrombotic state, however data is awaited in those with no underlying prothrombotic states. TIPS and liver transplant may be feasible even in the setting of PVT however proper selection of candidates and type of surgery is warranted. Thrombolysis and thrombectomy have some role. TARE is a new modality for management of HCC with portal vein invasion. ( J CLIN EXP HEPATOL 2015;5:22-40)

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Section: Tipsmentioning

confidence: 99%

Section: Tipsmentioning

confidence: 99%

Portal Vein Thrombosis

Chawla

Bodh

2015

Journal of Clinical and Experimental Hepatology

149

147

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“…The tissue harmonic imaging mode was used to maximize the diagnostic effectiveness of baseline US. This specific technique uses a low applied acoustic pressure to produce images based on nonlinear acoustic interaction between the ultrasound system and microbubbles that oscillate and resonate, giving continuous contrast enhancement to gray-scale images [23]. SonoVue (Bracco, Milan) is a second-generation contrast agent consisting of stabilized microbubbles of sulfur hexafluoride gas [24].…”

Section: Us and Contrast-enhanced Usmentioning

confidence: 99%

Contrast-enhanced ultrasound: a new method for TIPS follow-up

Micol¹,

Marsot²,

Boublay³

et al. 2011

Abdom Imaging

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“…In about 50%, restoration of portal blood fl ow is possible [115][116][117] . Patients with hepato-pulmonary syndrome [118][119][120] and patients with malignant portal hypertension [121] have been successfully treated with TIPS.…”

Section: Rare Indicationsmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt

Ochs¹

2005

Dig Dis

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The transjugular intrahepatic portosystemic shunt (TIPS) is an interventional treatment resulting in decompression of the portal system by creation of a side-to-side portosystemic anastomosis. Since its introduction 16 years ago, more than 1,000 publications have appeared demonstrating broad acceptance and increasing clinical use. This review summarizes our present knowledge about technical aspects and complications, follow-up of patients and indications. A technical success rate near 100% and a low occurrence of complications clearly depend on the skills of the operator. The follow-up of the TIPS patient has to assess shunt patency, liver function, hepatic encephalopathy and the possible development of hepatocellular carcinoma. Shunt patency can best be monitored by duplex sonography and can avoid routine radiological revision. Short-term patency may be improved by anticoagulation, while such a treatment does not influence long-term patency. Stent grafts covered with expanded polytetrafluoroethylene show promising long-term patency comparable with that of surgical shunts. With respect to the indications of TIPS, much is known about treatment of variceal bleeding and refractory ascites. The thirteen randomized studies that are available to date show that survival is comparable in patients receiving TIPS or endoscopic treatment for acute or recurrent variceal bleeding. Another group comprises patients with refractory ascites and related complications, such as hepatorenal syndrome and hepatic hydrothorax. It has been demonstrated that TIPS improves these complications. Five randomized studies comparing TIPS with paracentesis and one study comparing TIPS with the peritoneo-venous shunt showed good response of ascites but controversial results on survival. In addition, TIPS has been successfully applied to patients with Budd-Chiari syndrome, portal vein thrombosis, before liver transplantation, and for the treatment of ectopic variceal bleeding.

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Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Treatment of Venous Symptomatic Chronic Portal Thrombosis in Non-cirrhotic Patients

Abstract: Percutaneous techniques for portal recanalization are an interesting alternative even in non-acute thrombosis. Once flow has been restored in the portal vein TIPS may be necessary to obtain an adequate outflow, hence facilitating and maintaining the portal flow.

Cited by 95 publications

References 20 publications

Portal Vein Thrombosis

Portal Vein Thrombosis

Contrast-enhanced ultrasound: a new method for TIPS follow-up

Transjugular Intrahepatic Portosystemic Shunt

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