Transjugular intrahepatic portosystemic shunts: current status.

Kerlan, Robert K.; LaBerge, Jeanne M.; Gordon, Roy L.; Ring, Ernest J.

doi:10.2214/ajr.164.5.7717204

Cited by 90 publications

(24 citation statements)

References 74 publications

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“…These complications are observed less frequently as operator experience is gained . 27 The second type of complication is directly related to the shunting of portal blood flow away from the liver. This includes hepatic encephalopathy and progressive deterioration of liver function.…”

Section: Discussionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt in patients with end-stage liver disease: Results in 85 patients

et al. 1996

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Transjugular intrahepatic portosystemic shunt (TIPS) is becoming an accepted procedure as a bridge to orthotopic liver transplantation (OLT) in patients with end-stage liver disease (ESLD) and bleeding from portal hypertension. It allows the immediate control of acute bleeding and decreases the risk of recurrent acute bleeding while the patient is awaiting OLT. We review in this report, our experience with 85 patients who underwent a TIPS procedure for gastrointestinal variceal bleeding from September 1991 until April 1994. All patients had liver cirrhosis and all had previous sclerotherapy before TIPS. Child-Pugh score was calculated at enrollment, and all patients were evaluated for possible OLT. Thirteen patients were Child A, 49 were Child B, and 23 were Child C. Fifty-three patients were candidates for OLT, and 32 were not. TIPS was performed urgently in 25 patients. At a median follow-up of pper gastrointestinal tract bleeding is a major U cause of death in patients with end-stage liver disease (ESLD) second only to progressive liver failure. 1,2 Surgical shunts and/or sclerotherapy are able to control the bleeding but have no effect on the underlying liver d i~e a s e .~.~ With improved management of patients undergoing orthotopic liver transplantation (OLT), this form of treatment has clearly become the most effective therapy for patients with ESLD.5,h However, this form of treatment is limited to patients who are able to withstand such major surgery. The waiting time for OLT candidate patients has been increasing because of the limited donor pool and the continuous expansion of indications for OLT. Recently, transjugular intrahepatic portosystemic shunt (TIPS) has been considered in patients with ESLD mainly for acute variceal bleeding that cannot be successfully controlled with medical treatment and recurrent variceal bleeding in patients who are refractory or intolerant to conventional medical management.'-I4 TIPS may serve as a bridge to OLT without the negative technical effect observed with central surgical shunts during the transplantation 582 days (range, 1 to 1,095), 35 patients underwent transplantation, 21 patients died, and 29 patients are still alive and did not undergo transplantation. Technical complications were observed in 7% of patients and new onset of clinical encephalopathy in 37%. The 30-day mortality rate after TIPS was 13%. Actuarial survival was 60% at 1 and 3 years. Child class C and urgent TIPS were shown to be two independent predictor factors for mortality. TIPS was shown to be a valuable procedure, not only as a bridge to OLT but also as palliation for bleeding from portal hypertension in patients who were not candidates for either surgical shunt or OLT. However, its role in bleeding patients with acceptable liver function needs further investigation. Copyright 0 1996 by the American Association for the Study of Liver Diseases procedure and the possible morbidity and mortality associated with shunt procedure itself.We report our experience in patients who underwent TIPS reg...

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Section: Discussionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt in patients with end-stage liver disease: Results in 85 patients

et al. 1996

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“…TIPS is a non selective shunt, has its own limitations like shunt occlusion, stenosis, availability and vascular anatomy. TIPS require intense post procedure endoscopic surveillance and it is temporary short term measure (34,35) . Esopagogastric devascularisation has prime role in the management of emergency and elective variceal bleeding, it's indication already mentioned in the material and methods (30,36) .…”

Section: Discussionmentioning

confidence: 99%

Devascularization for Portal Hypertension not Obsolete: Technical Details and Experience of 104 Cases

Ali¹

2017

jmscr

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“…19 However, TIPS has been performed successfully in patients with cirrhosis with occluded portal veins. [20][21][22][23][24][25][26][27] Table 1 lists the features of these patients obviously selected in being considered potentially remediable at the time of OLT.…”

Section: Discussionmentioning

confidence: 99%

Successful recanalization of portal vein thrombosis before liver transplantation using transjugular intrahepatic portosystemic shunt

Liatsos

Vlachogiannakos

Patch

et al. 2001

Liver Transplantation

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A frequent complication in patients with end-stage liver disease is portal vein thrombosis (PVT). Although PVT is not considered an absolute contraindication to orthotopic liver transplantation (OLT), more complex surgery is required and patients have more postoperative complications and greater mortality rates. We describe 2 patients who experienced complete PVT either while waiting for liver transplantation or during the workup, resulting in acute deterioration of liver function. Recanalization of the portal vein was successfully performed in both patients using transjugular intrahepatic portosystemic stent shunt (TIPS), and patency was maintained by the addition of anticoagulation therapy. They subsequently underwent successful OLTs and remain well. In conclusion, we believe that TIPS placement can be performed safely in patients with recent PVT, ensuring the patency of the portal vein until OLT. (Liver Transpl 2001;7:453-460.)

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Transjugular intrahepatic portosystemic shunts: current status.

Cited by 90 publications

References 74 publications

Transjugular intrahepatic portosystemic shunt in patients with end-stage liver disease: Results in 85 patients

Transjugular intrahepatic portosystemic shunt in patients with end-stage liver disease: Results in 85 patients

Devascularization for Portal Hypertension not Obsolete: Technical Details and Experience of 104 Cases

Successful recanalization of portal vein thrombosis before liver transplantation using transjugular intrahepatic portosystemic shunt

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