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direct intrahepatic portacaval shunt

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https://www.readbyqxmd.com/read/27049485/management-of-gastroesophageal-varices-in-cirrhotic-patients-current-status-and-future-directions
#1
Nobuyuki Toshikuni, Yoshitaka Takuma, Mikihiro Tsutsumi
Bleeding from gastroesophageal varices (GEV) is a serious event in cirrhotic patients and can cause death. According to the explosion theory, progressive portal hypertension is the primary mechanism underlying variceal bleeding. There are two approaches for treating GEV: primary prophylaxis to manage bleeding or emergency treatment for bleeding followed by secondary prophylaxis. Treatment methods can be classified into two categories: 1) Those used to decrease portal pressure, such as medication (i.e., nonselective β-blockers), radiological intervention [transjugular intrahepatic portosystemic shunt (TIPS)] or a surgical approach (i...
May 2016: Annals of Hepatology
https://www.readbyqxmd.com/read/25957003/randomized-trials-of-endoscopic-therapy-and-transjugular-intrahepatic-portosystemic-shunt-versus-portacaval-shunt-for-emergency-and-elective-treatment-of-bleeding-gastric-varices-in-cirrhosis
#2
RANDOMIZED CONTROLLED TRIAL
Marshall J Orloff, Robert J Hye, Henry O Wheeler, Jon I Isenberg, Kevin S Haynes, Florin Vaida, Barbara Girard, Karen J Orloff
IMPORTANCE: Bleeding esophageal varices has been studied extensively, but bleeding gastric varices (BGV) has received much less investigation. However, BGV has been reported in ≤ 30% of patients with acute variceal bleeding. In our studies of 1,836 bleeding cirrhotics, 12.7% were bleeding from gastric varices. BGV mortality rate of 45-55% has been reported. The BGV literature has mainly involved retrospective case reports, often with short-term follow-up. OBJECTIVE: We sought to describe the results of a prospective, randomized, controlled trial (RCT) in unselected, consecutive patients with BGV comparing endoscopic therapy (ET) with portacaval shunt (PCS; n = 518), and later comparing emergency transjugular intrahepatic portosystemic shunt (TIPS) with emergency portacaval shunt (EPCS; n = 70)...
June 2015: Surgery
https://www.readbyqxmd.com/read/25905983/pretransplant-portal-vein-recanalization-transjugular-intrahepatic-portosystemic-shunt-in-patients-with-complete-obliterative-portal-vein-thrombosis
#3
Riad Salem, Michael Vouche, Talia Baker, Jose Ignacio Herrero, Juan Carlos Caicedo, Jonathan Fryer, Ryan Hickey, Ali Habib, Michael Abecassis, Felicitas Koller, Robert Vogelzang, Kush Desai, Bartley Thornburg, Elias Hohlastos, Scott Resnick, Robert J Lewandowski, Kent Sato, Robert K Ryu, Daniel Ganger, Laura Kulik
BACKGROUND: Chronic, obliterative portal vein (PV) thrombosis (PVT) represents a relative contraindication to liver transplantation (LT) in some centers. When PV thromboembolectomy is not feasible, alternative techniques (portacaval hemitransposition, portal arterialization, multivisceral transplantation) are associated with suboptimal outcomes. In cases where a chronically thrombosed PV has become obliterated, we developed PV recanalization (PVR)-transjugular intrahepatic portosystemic shunt (TIPS) to potentiate LT...
November 2015: Transplantation
https://www.readbyqxmd.com/read/25881512/emergent-salvage-direct-intrahepatic-portocaval-shunt-procedure-for-acute-variceal-hemorrhage
#4
Thomas J Ward, Tust Techasith, John D Louie, Gloria L Hwang, Lawrence V Hofmann, Daniel Y Sze
PURPOSE: To review the safety and effectiveness of direct intrahepatic portocaval shunt (DIPS) creation with variceal embolization for acute variceal hemorrhage after a failed transjugular intrahepatic portosystemic shunt (TIPS) creation attempt or in patients with prohibitive anatomy. MATERIALS AND METHODS: Transjugular intrahepatic portosystemic shunt and DIPS procedures performed for variceal hemorrhage between January 2008 and July 2014 were reviewed. The default procedure was TIPS creation, with DIPS creation reserved for patients with unfavorable anatomy or who had technically unsuccessful TIPS creation...
June 2015: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/24402314/fifty-three-years-experience-with-randomized-clinical-trials-of-emergency-portacaval-shunt-for-bleeding-esophageal-varices-in-cirrhosis-1958-2011
#5
Marshall J Orloff
IMPORTANCE: Emergency treatment of bleeding esophageal varices (BEV) consists mainly of endoscopic and pharmacologic measures, with transjugular intrahepatic portal-systemic shunt (TIPS) performed when bleeding is not controlled. Surgical shunt has been relegated to salvage. At the University of California, San Diego, Medical Center, our group has conducted 10 studies of emergency portacaval shunt (EPCS) during 46 years. OBJECTIVE: To describe 2 randomized clinical trials (RCTs) conducted from 1988 to 2011 in unselected consecutive patients who received emergency treatment for BEV...
February 2014: JAMA Surgery
https://www.readbyqxmd.com/read/19527850/direct-intrahepatic-portocaval-shunt
#6
REVIEW
Bryan D Petersen, Timothy W I Clark
The direct intrahepatic portacaval shunt (DIPS) is a modification of the TIPS procedure, using intravascular ultrasound-guidance, combined with fluoroscopy. The DIPS procedure was initially conceived to increase the durability of shunt patency and extend the spectrum of patients with portal hypertension for whom endovascular portocaval shunting can be performed. The DIPS procedure involves intravascular ultrasound-guided puncture from the inferior vena cava to the portal vein through the caudate lobe of the liver...
December 2008: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/19083145/direct-intrahepatic-portocaval-shunt-through-transhepatic-puncture-via-retrohepatic-inferior-vena-cava-applied-anatomical-study
#7
Shen-ping Yu, Guo-liang Chu, Jian-yong Yang, Li He, Hua-qiao Wang
BACKGROUND: DIPS is to create a portosystemic shunt directly between the portal vein and the retrohepatic inferior vena cava (RIVC) without passing through the hepatic vein. It has been recommended that the DIPS could be applied when routine TIPS is unsuccessful or the patient has anatomical variations of the hepatic vein. The aim of this study was to identify the safe area of the RIVC where the DIPS can be safely established. MATERIALS AND METHODS: The lengths of the safe and unsafe areas of the RIVC were measured...
June 2009: Surgical and Radiologic Anatomy: SRA
https://www.readbyqxmd.com/read/18096542/intravascular-us-guided-direct-intrahepatic-portocaval-shunt-with-an-expanded-polytetrafluoroethylene-covered-stent-graft
#8
Hanno Hoppe, Stephen L Wang, Bryan D Petersen
PURPOSE: To retrospectively evaluate the midterm patency rate of the nitinol (Viatorr, W.L. Gore and Associates, Flagstaff, Ariz) stent-graft for direct intrahepatic portacaval shunt (DIPS) creation. MATERIALS AND METHODS: Institutional Review Board approval for this retrospective HIPAA-compliant study was obtained with waiver of informed consent. DIPS was created in 18 men and one woman (median age, 54 years; range, 45-65 years) by using nitinol polytetrafluoroethylene (PTFE)-covered stent-grafts...
January 2008: Radiology
https://www.readbyqxmd.com/read/17991098/direct-percutaneous-portocaval-shunt-creation-for-haematemesis-case-report
#9
M Pianta, N Tran, M Given, S M Lyon
Creating a direct intrahepatic portocaval shunt (DIPS) is a procedure similar to a transjugular intrahepatic portosystemic shunt (TIPS) in patients for whom the latter is not appropriate due to unsuitable hepato-venous and porto-venous anatomy. We present a patient for whom TIPS was not possible, and DIPS successful.
December 2007: Australasian Radiology
https://www.readbyqxmd.com/read/17097021/effects-of-hepatotrophic-factors-on-the-liver-after-portacaval-shunt-in-rats-with-portal-hypertension
#10
Zhong-tao Zhang, Peng Jiang, Yu Wang, Jian-She Li, Jian-guo Xue, Yan-zhong Zhou, Zhu Yuan
BACKGROUND: Portacaval shunt (PCS) prevent hepatotrophic factors from flowing into the liver, but they enter directly the systemic circulation and worsen liver injury. This study was designed to investigate the effects of hepatotrophic factors through the portal vein on the liver in rats with portal hypertension after portacaval shunt. METHODS: Intrahepatic portal hypertension (IHPH) was induced by intragastric administration of carbon tetrachloride, and end-to-side PCS was performed...
October 20, 2006: Chinese Medical Journal
https://www.readbyqxmd.com/read/16729230/percutaneous-transjugular-direct-porto-caval-shunt-in-patients-with-budd-chiari-syndrome
#11
A Quateen, M Pech, T Berg, A Bergk, P Podrabsky, R Felix, J Ricke
The purpose of the study was to evaluate the feasibility and effectiveness of direct porto-caval shunts in patients with Budd-Chiari syndrome (BCS) in whom there is no access to the hepatic veins during transjugular intrahepatic portosystemic shunt (TIPSS). We included six consecutive patients with fulminant/acute Budd-Chiari syndrome (mean age: 35 years) in whom a conventional TIPSS was not possible due to inaccessible hepatic veins. We performed a direct porto-caval shunt via a transhepatic approach. Patients were followed up by means of clinical examination, laboratory investigations, and Doppler ultrasound...
July 2006: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/16313865/management-of-the-cirrhotic-patient-that-needs-surgery
#12
Christopher L Bell, D Rohan Jeyarajah
Conditions that necessitate surgery frequently arise in patients with chronic liver disease and cirrhosis. Because cirrhosis has the ability to cause physiologic derangements in every organ system in the body, clinicians face significant challenges in preoperative preparation of the patient with cirrhosis in order to decrease postoperative morbidity and mortality. Emergent operations add an extra dimension of complexity to the clinical picture, due to limited preoperative time to prepare the patient with cirrhosis for surgery...
December 2005: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/15965877/-surgical-treatment-of-portal-hypertension
#13
REVIEW
M Wolff, A Hirner
A switch to decompressive shunt procedures is mandatory if endoscopic therapy fails to control recurrent variceal hemorrhage. Surgical shunt procedures continue to be safe, highly effective and durable procedures to control variceal bleeding in patients with low operative risk and good liver function (Child A). In cirrhotics, elective operations using portal flow preserving techniques such as a selective distal splenorenal shunt (Warren) or a partial portocaval small diameter interposition shunt (Sarfeh) should be preferred...
June 2005: Zentralblatt Für Chirurgie
https://www.readbyqxmd.com/read/15361560/intravascular-ultrasound-guided-direct-intrahepatic-portacaval-shunt-midterm-follow-up
#14
COMPARATIVE STUDY
Bryan Petersen, Christoph Binkert
PURPOSE: To describe the midterm patency and clinical results of the intravascular ultrasound (US)-guided direct intrahepatic portacaval shunt (DIPS) procedure for the treatment of intractable ascites and variceal bleeding. MATERIALS AND METHODS: From February 23, 1999, to December 18, 2002, inferior vena cava (IVC)-to-portal vein (PV) shunts were created in 40 patients for ascites (n = 35) and bleeding (n = 5). Intravascular US was used to guide direct puncture from the IVC to the PV...
September 2004: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/13413692/splenoportagraphy-in-portal-hypertension-its-value-in-selecting-the-operative-procedure-of-choice
#15
W P MIKKELSEN, A C PATTISON
Splenoportagraphy has become an almost indispensable adjunct to the surgical management of portal hypertension. In many instances it will provide the basis for the selection of the operative procedure. Certain instances of intrahepatic portal hypertension due to cirrhosis that might better be managed by splenorenal shunt rather than by the generally preferred method of direct end-to-side portacaval shunt may be determined by this procedure. The procedure finds its greatest application in the accurate delineation of the three major types of extrahepatic portal hypertension, each of which demands a different surgical approach...
April 1957: California Medicine
https://www.readbyqxmd.com/read/12714681/transvenous-extrahepatic-portacaval-shunt-feasibility-study-in-a-swine-model
#16
Michael J Wallace, Kamran Ahrar, L Clifton Stephens, Kenneth C Wright
PURPOSE: To evaluate the feasibility of intravascular ultrasonography (US)-guided access to the extrahepatic segment of the main portal vein (PV) to create a transvenous extrahepatic portacaval shunt (TEPS) as an easier and more durable alternative to transjugular intrahepatic portosystemic shunt. MATERIALS AND METHODS: PV access from the inferior vena cava (IVC) to the main PV was performed in eight pigs by using intravascular US guidance. Either a prototype stent-graft (n = 6) or Wallgraft (n = 2) was used to create the shunt...
July 2003: Radiology
https://www.readbyqxmd.com/read/12592481/portacaval-shunt-creation-using-the-percutaneous-transhepatic-transjugular-technique
#17
C Aytekin, F Boyvat, A Firat, M Coşkun, S Boyacioğlu
BACKGROUND: The feasibility and efficacy of portacaval shunt creation through the transhepatic and transjugular approach were evaluated in patients with portal hypertension whose hepatic venous anatomies were unsuitable for the standard shunt procedure. METHODS: Portacaval shunts were created via percutaneous transhepatic access in six patients. We used snares to target the portal vein and the inferior vena cava. Then a needle was introduced percutaneously and advanced through the snares...
March 2003: Abdominal Imaging
https://www.readbyqxmd.com/read/12532459/direct-intrahepatic-portacaval-shunt-an-experimental-study
#18
Jian-Jun Luo, Zhi-Ping Yan, Kang-Rong Zhou, Sheng Qian
AIM: To determine the feasibility of creating direct intrahepatic portacaval shunt (DIPS) in swine with puncture under sonographic guidance. METHODS: DIPS was created in 10 domestic swine under sonographic guidance. Liver function, blood ammonia level and portosystemic gradient (PSG) were compared before and after the procedure. Patency of shunt was followed by portography every 7 days after DIPS. RESULTS: DIPS was successfully established in all 10 swine without any complications...
February 2003: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/12525583/intravascular-ultrasound-guided-direct-intrahepatic-portacaval-shunt-description-of-technique-and-technical-refinements
#19
Bryan Petersen
PURPOSE: This is a prospective study designed to demonstrate the safety and feasibility of creating a direct inferior vena cava (IVC)-to-portal vein shunt with use of a new type of intravascular ultrasound (IVUS) to guide the puncture and completing the shunt with the use of a polytetrafluoroethylene (PTFE)-covered stent graft. MATERIALS AND METHODS: IVC-to-portal vein shunts were created in 31 sequential patients for ascites (n = 31) or bleeding (n = 8). Transfemorally placed IVUS transducers were positioned in the IVC to guide the puncture from the IVC to the portal vein, which was performed from a transjugular approach with a modified Rosch-Uchida liver access set...
January 2003: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/11875086/main-portal-vein-access-in-transjugular-intrahepatic-portosystemic-shunt-procedures-use-of-three-dimensional-ultrasound-to-ensure-safety
#20
Steven C Rose, Cynthia Behling, Anne C Roberts, Dolores H Pretorius, Thomas R Nelson, Thomas B Kinney, Eliezer Masliah, Tarek I Hassanein
PURPOSE: To document the safety of main portal vein (PV) access to create transjugular portosystemic intrahepatic shunts (TIPS), provided that three-dimensional ultrasonography (3D US) can document the puncture to have entered a surface of the PV suitable for tamponade. MATERIALS AND METHODS: In 11 patients who underwent conventional TIPS creation (n = 10) or a transjugular portacaval shunt procedure (n = 1), the puncture was found angiographically to enter the main PV...
March 2002: Journal of Vascular and Interventional Radiology: JVIR
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