Transjugular Intrahepatic Portosystemic Shunts in High-Risk Patients

Shin, David S.; Vo, Hong; Johnson, Guy E.; Pichler, Raimund; Biggins, Scott W.

doi:10.1055/s-0040-1712117

Cited by 3 publications

(4 citation statements)

References 86 publications

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“…Transthoracic echocardiogram, which may reveal pathology, such as cirrhotic cardiomyopathy, pulmonary hypertension, or congestive heart failure, should be performed as part of the evaluation for TIPS. Conventionally, patients with MELD of ≥18 have been considered suboptimal candidates for this procedure, as well as those with advanced age, cardiovascular disease, and sarcopenia, due to a higher risk of such complications 9 . The use of smaller diameter TIPS (8–10 mm) has been associated with a lower risk of post-TIPS encephalopathy 10 …”

Section: Transjugular Intrahepatic Portosystemic Shunt and Alternativ...mentioning

confidence: 99%

“…Conventionally, patients with MELD of ≥ 18 have been considered suboptimal candidates for this procedure, as well as those with advanced age, cardiovascular disease, and sarcopenia, due to a higher risk of such complications. [9] The use of smaller diameter TIPS (8-10 mm) has been associated with a lower risk of post-TIPS encephalopathy. [10] Alternative therapies, such as permanent indwelling peritoneal catheters, have not been well established due to low-quality studies and an average infection rate of 12.7%.…”

Section: Transjugular Intrahepatic Portosystemic Shunt and Alternativ...mentioning

confidence: 99%

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Management of ascites and volume overload in patients with cirrhosis

Kwong,

Norman,

Biggins

2024

Clinical Liver Disease

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Volume overload and ascites, or the accumulation of fluid in the abdomen, is a debilitating manifestation of chronic liver disease and portal hypertension that is associated with reduced survival and quality of life. [1,2] In patients with compensated cirrhosis, ascites occur in 5%-10% per year, and its onset is a key indicator of hepatic decompensation and progression of liver disease. [3] The presence of volume overload and, specifically, ascites increases the risk of additional complications, including malnutrition, infection, electrolyte imbalance, and hepatorenal syndrome.

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Section: Transjugular Intrahepatic Portosystemic Shunt and Alternativ...mentioning

confidence: 99%

Section: Transjugular Intrahepatic Portosystemic Shunt and Alternativ...mentioning

confidence: 99%

Management of ascites and volume overload in patients with cirrhosis

Kwong,

Norman,

Biggins

2024

Clinical Liver Disease

Self Cite

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“…The most challenging step is the direct cannulation of the portal branch from the selected hepatic vein, as the needle pass is performed essentially blind in a three-dimensional volume with a two-dimensional roadmap for reference. To mitigate some of these guiding challenges, alternative image guidance options such as intracardiac echocardiography (ICE) catheter-guided portal access, wire-targeting access (gun-sight technique) and cone-beam computed tomography (CBCT)-guided access techniques have been introduced (Lukies et al 2022 ; Trieu et al 2017 ; Morrison et al 2017 ; Lang et al 2017 ; Shin et al 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Safety and feasibility of a novel bi-directional portal vein access kit during transjugular intrahepatic portosystemic shunt creation

et al. 2023

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Background Transjugular intrahepatic portosystemic shunt (TIPS) creation remains as one of the more technically challenging endovascular procedures. Portal vein access from the hepatic vein often requires multiple needle passes, which increases procedure times, risk of complications, and radiation exposure. With its bi-directional maneuverability, the Scorpion X access kit may be a promising tool for easier portal vein access. However, the clinical safety and feasibility of this access kit has yet to be determined. Materials and methods In this retrospective study, 17 patients (12 male, average age 56.6 ± 9.01) underwent TIPS procedure using Scorpion X portal vein access kits. The primary endpoint was time taken to access the portal vein from the hepatic vein. The most common indications for TIPS were refractory ascites (47.1%) and esophageal varices (17.6%). Radiation exposure, total number of needle passes, and intraoperative complications were recorded. Average MELD Score was 12.6 ± 3.39 (range: 8–20). Results Portal vein cannulation was successfully achieved in 100% of patients during intracardiac echocardiography-assisted TIPS creation. Total fluoroscopy time was 39.31 ± 17.97 min; average radiation dose was 1036.76 ± 644.15 mGy, while average contrast dose was 120.59 ± 56.87 mL. The average number of passes from the hepatic vein to the portal vein was 2 (range: 1–6). Average time to access the portal vein once the TIPS cannula was positioned in the hepatic vein was 30.65 ± 18.64 min. There were no intraoperative complications. Conclusions Clinical utilization of the Scorpion X bi-directional portal vein access kit is both safe and feasible. Utilizing this bi-directional access kit resulted in successful portal vein access with minimal intraoperative complications. Level of evidence Retrospective cohort.

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“…Further, TIPS placement is used as salvage therapy for acute gastrointestinal variceal haemorrhage, as secondary prophylaxis for oesophageal or gastric variceal bleeding, and as early prophylaxis after initial variceal bleeding. [1][2][3][4] Despite its efficacy, however, TIPS placement remains one of the more technically challenging endovascular procedures .…”

Section: Introductionmentioning

confidence: 99%

Advanced portal venous access techniques for transjugular intrahepatic portosystemic shunt placement

Partovi

Shwaiki

et al. 2021

BMJ Open Gastroenterol

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IntroductionTransjugular intrahepatic portosystemic shunt (TIPS) placement is a well-established but technically challenging procedure for the management of sequelae of end-stage liver disease. Performed essentially blindly, traditional fluoroscopically guided TIPS placement requires multiple needle passes and prolonged radiation exposure to achieve successful portal venous access, thus increasing procedure time and the risk of periprocedural complications. Several advanced image-guided portal access techniques, including intracardiac echocardiography (ICE)-guided access, cone-beam CT (CBCT)-guided access and wire-targeting access techniques, can serve as alternatives to traditional CO2 portography-based TIPS creation.MethodsA literature search was performed on the electronic databases including MEDLINE and Embase, from 2000 to the present to identify all relevant studies. The reference list also included studies identified manually, and studies referenced for other purposes.FindingsThe main benefit of these advanced access techniques is that they allow the operator to avoid essentially blind portal punctures, and the ability to visualise the target, thus reducing the number of required needle passes. Research has shown that ICE-guided access can decrease the radiation exposure, procedure time and complication rate in patients undergoing TIPS placement. This technique is particularly useful in patients with challenging portal venous anatomy. However, ICE-guided access requires additional equipment and possibly a second operator. Other studies have shown that CBCT-guided access, when compared with traditional fluoroscopy-guided access, provides superior visualisation of the anatomy with similar amount of radiation exposure and procedure time. The wire-targeting technique, on the other hand, appears to offer reductions in procedure time and radiation exposure by enabling real-time guidance. However, this technique necessitates percutaneous injury to the liver parenchyma in order to place the target wire.ConclusionAdvanced portal access techniques have certain advantages over the traditional fluoroscopically guided TIPS access. To date, few studies have compared these advanced guided access options, and further research is required.

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Transjugular Intrahepatic Portosystemic Shunts in High-Risk Patients

Cited by 3 publications

References 86 publications

Management of ascites and volume overload in patients with cirrhosis

Management of ascites and volume overload in patients with cirrhosis

Safety and feasibility of a novel bi-directional portal vein access kit during transjugular intrahepatic portosystemic shunt creation

Advanced portal venous access techniques for transjugular intrahepatic portosystemic shunt placement

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