Transjugular Portal Venography and Radiologic Portacaval Shunt: An Experimental Study

Rösch, Josef; Hanafee, William N.; Snow, Harold D.

doi:10.1148/92.5.1112

Cited by 341 publications

(100 citation statements)

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“…In 1969, TIPSS, which could decrease the portal pressure nonsurgically, was introduced after animal test results by Rosch et al (9), and then in 1988, it proved effective in humans by using a metal stent (19). The purpose of TIPSS is to increase survival of patients with liver cirrhosis through reducing the portal pressure for stopping gastric or esophageal variceal bleeding and preventing rebleeding.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Factors of the Long-Term Survival after Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Gastric and Esophageal Variceal Bleeding

et al. 2002

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Transjugular intrahepatic portosystemic shunt (TIPSS) is a promising method of treatment for gastric or esophageal variceal bleeding. This study was performed to determine the prognostic factors contributing to the survival of patients after TIPSS for gastric or esophageal variceal bleeding. One hundred and fifty-five patients who underwent TIPSS between September 1991 and March 2001 were followed up by clinical examination, upper gastrointestinal endoscopy, and Duplex sonography. The mean portohepatic pressure gradient prior to TIPSS was 20.5±9.93 mmHg and dropped to 10.7±6.62 mmHg after TIPSS (p<0.001). The cumulative survival rate was 75.1% at 6 months, 66.6% at 1 yr, 58.4% at 2 yr, and 38.1% at 5 yr. Survival after TIPSS was inversely related to the Child-Pugh classification (p<0.05). The rebleeding rate was 18.3% at 6 months, 21.0% at 1 yr, 32.8% at 2 yr, and 53.1% at 5 yr. The causes of deaths were hepatic failure (53.5%), recurrent variceal bleeding (11.6%), pneumonia (4.6%), sepsis (3.5%), hepatic encephalopathy (2.3%), and unknown (17.4%). Multivariate analysis (Cox proportional hazard model) revealed that the Child-Pugh classification and age were statistically significant independent prognostic factors. In conclusion, TIPSS is an effective method of treatment for variceal bleeding in cases where other treatment modalities including endoscopic therapy are unsuccessful and the most important prognostic factors are preprocedural hepatic reserve (Child-Pugh class) and age.

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Section: Discussionmentioning

confidence: 99%

“…Since percutaneous decompression of portal hypertension was reported by Rosch et al in 1969, transjugular intrahepatic portosystemic shunt (TIPSS) has been known as an effective treatment method (9).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors of the Long-Term Survival after Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Gastric and Esophageal Variceal Bleeding

et al. 2002

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“…W 1969 r. Rosch po raz pierwszy opisał w badaniach eksperymentalnych utworzenie drogi między żyłą wątrobową a żyłą wrotną z dostępu przez żylnego [124]. Uzyskanie lepszych wyników leczenia za pomocą TIPS było możliwe dopiero po wprowadzeniu metalowych stentów w latach 70.…”

Section: Przezżylne śRódwątrobowe Zespolenia Wrotno-systemoweunclassified

Management of variceal haemorrhage

Wróblewski¹,

Dâbrowski²

2010

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StreszczenieŻylaki przełyku są bardzo poważnym powikłaniem nadciśnie-nia wrotnego, którego najczęstszą przyczyną jest marskość wątroby. Krwawienie z żylaków przełyku często ma dramatyczny przebieg, może nawracać i wiąże się ze znaczną śmier-telnością. Dzięki aktualnie stosowanym metodom leczenia śmiertelność związana z krwawieniem w ostatnich 2 dekadach zmniejszyła się o połowę, z 40% do ok. 20%. Stało się tak dzięki lepszemu zrozumieniu mechanizmów prowadzą-cych do wzrostu ciśnienia wrotnego oraz udoskonaleniu metod leczenia farmakologicznego, endoskopowego i radiologicznego. Nowoczesne leczenie krwawienia z żylaków przełyku powinno uwzględnić miejsce jego prowadzenia -oddział intensywnego nadzoru, ostrożną stabilizację hemodynamiczną, skuteczne leczenie zakażenia, zastosowanie leków obniżających ciśnienie wrotne. Kluczową rolę odgrywa terapia endoskopowa, gdzie metodą z wyboru jest opaskowanie, a alternatywą skleroterapia. Istotne znaczenie ma profilaktyka nawrotu krwawienia oraz profilaktyka pierwszego krwawienia. W przypadku niepowodzenia leczenia endoskopowego i farmakologicznego alternatywą jest TIPS (transjugular porto-systemic shunt) i dotyczy to zarówno leczenia ostrego krwawienia, jak i profilaktyki wtórnej. AbstractOesophageal varices are a very severe complication of portal hypertension which is mainly caused by hepatic cirrhosis. Variceal bleeding often has a dramatic course, may recur and is associated with substantial mortality. Thanks to the currently used methods of treatment, in the last two decades the mortality rate due to bleeding has decreased by half, from 40 to 20%. This was possible owing to better understanding of the mechanisms that cause an increase in portal hypertension, and thanks to improvement in pharmacological, endoscopic and radiological treatments. The modern management of oesophageal variceal bleeding should take into consideration the place of treatment -the intensive care unit, cautious haemodynamic stabilization, effective treatment of infection and administration of drugs reducing portal pressure. Endoscopic therapy plays a fundamental role, with variceal band ligation being the treatment of choice and injection sclerotherapy as an alternative option. Very important are rebleeding prevention and primary bleeding prophylaxis. When endoscopic and pharmacological treatments fail, transjugular porto-systemic shunt (TIPS) is an alternative both for the treatment of acute bleeding and as secondary prophylaxis. WprowadzenieŻylaki przełyku są częstym i bardzo groźnym powikła-niem nadciśnienia wrotnego, które cechuje się wzrostem ciśnienia w obrębie żyły wrotnej powyżej 12 mm Hg. Ponieważ bezpośredni pomiar ciśnienia w żyle wrotnej oraz określenie prawidłowego zakresu ciśnień w układzie wrotnym są trudne, jako kryterium nadciśnienia wrotnego przyjmuje się gradient ciśnień między żyłą wrotną a żyłą główną dolną (ang. hepatic venous pressure gradient -HVPG) większy niż 5-10 mm Hg. Najczęstszą przyczyną nadciśnienia wrotnego, bo aż w ok. 90% przypadków, jest marskość wątroby (klasyf...

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“…The technique, modified from that of Rosch et al [2], involved placement of a balloon-expandable metal stent within a liver-tissue track previously formed by a transjugular needle puncture. Unlike previously described intrahepatic shunts [2][3][4][5][6][7], ours directly connected the inferior vena cava with the portal bifurcation in a side-to-side fashion. Most of our reported shunts remained patent for as long as they were under study; nevertheless, more than half required recanalization of the lumen by balloon angioplasty after early thrombosis.…”

mentioning

confidence: 99%

Expandable intrahepatic portacaval shunt stents in dogs with chronic portal hypertension

Palmaz¹,

Garcı́a²,

Sibbitt³

et al. 1986

American Journal of Roentgenology

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Transjugular Portal Venography and Radiologic Portacaval Shunt: An Experimental Study

Abstract: BOOK REVIEWS The puzzle people: memoirs of a transplant surgeon. By Thomas E Starzl.

Cited by 341 publications

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Prognostic Factors of the Long-Term Survival after Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Gastric and Esophageal Variceal Bleeding

Prognostic Factors of the Long-Term Survival after Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Gastric and Esophageal Variceal Bleeding

Management of variceal haemorrhage

Expandable intrahepatic portacaval shunt stents in dogs with chronic portal hypertension

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