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Transjugular portosystem

Georg Böning, Willie M Lüdemann, Julius Chapiro, Martin Jonczyk, Bernd Hamm, Rolf W Günther, Bernhard Gebauer, Florian Streitparth
PURPOSE: The aim of this study was to evaluate the feasibility of cone-beam computed tomography (CBCT)-based real-time 3-D guidance of TIPSS placement and its positioning compared to standard guiding methods. MATERIALS AND METHODS: In a prospective, randomized, consecutive study design from 2015 to 2017, we included 21 patients in the CBCT guided group and 15 patients in the ultrasound (US) guided group. The prospective groups were compared in terms of success rate of intervention, portal vein puncture/procedure time, number of puncture attempts and applied dose...
March 14, 2018: Cardiovascular and Interventional Radiology
Kakharman Yesmembetov, Zhansaya Muratova, Sergey Borovskiy, Irina Ten, Kulpash Kaliaskarova
We report the clinical case of 23-year-old patient with liver cirrhosis of unknown genesis, significant resistant ascites, and 2 episodes of bleeding from esophageal varices. Evaluation did not find any cause of liver disease, and the patient was placed on the transplant wait list due to subcompensated liver function (Model for End-Stage Liver Disease score of 16, Child-Pugh class B) and poorly controlled severe portal hypertension. After treatment with diuretics, largevolume paracentesis, antibiotics, and vasoconstrictors, hepatorenal syndrome and spontaneous bacterial peritonitis resolved and liver function improved significantly...
March 2018: Experimental and Clinical Transplantation
Ramzy C Khabbaz, R Peter Lokken, Yi-Fan Chen, Andrew J Lipnik, James T Bui, Charles E Ray, Ron C Gaba
PURPOSE: To evaluate the capability of albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grades in predicting transplant-free survival (TFS) in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS: This single-center retrospective study included 342 ALBI and 337 PALBI patients (62% men; age 53-54 years) with cirrhosis (median MELD 15) and portal hypertension complications (variceal bleeding, 55%; ascites, 35%; other, 10%) who underwent TIPS between 1998 and 2017...
March 7, 2018: Cardiovascular and Interventional Radiology
Hozan Mufty, Athanasios Katsargyris, Sabrina Houthoofd, Inge Fourneau, Eric Verhoeven, Geert Maleux
INTRODUCTION: Fenestrated/branched thoracic endovascular aneurysm repair (F/Br-TEVAR) is a new minimal invasive treatment option for patients with post-dissection thoracoabdominal aortic aneurysms. This specific pathology is challenging to F/Br-TEVAR, especially when target vessels originate from the false lumen. Crossing from the true lumen into the false lumen to catheterize such target vessels may prove cumbersome in the usually thickened dissection flap. TECHNIQUE: We describe a bailout technique when standard catheterization techniques fail, by using a transjugular intrahepatic portosystemic shunt (TIPS)-needle to perforate the dissection flap...
March 6, 2018: Cardiovascular and Interventional Radiology
Sabine K Maschke, Thomas Werncke, Julius Renne, Roman Kloeckner, Steffen Marquardt, Martha M Kirstein, Andrej Potthoff, Frank K Wacker, Bernhard C Meyer, Jan B Hinrichs
PURPOSE: To analyze the feasibility of 2D-perfusion angiography (2D-PA) to quantify flow and perfusion changes pre- and post-transjugular intrahepatic portosystemic shunt (TIPS) revision. MATERIALS AND METHODS: Fifteen consecutive patients (54 ± 14 years, seven men and eight women) scheduled for TIPS revision were included in this study. To quantify flow and perfusion changes caused by TIPS revision, digital subtraction angiography (DSA) series acquired during the revision were post-processed using a dedicated software...
March 3, 2018: Abdominal Radiology
Daniel da Costa, Cristián Montenegro, Patricio Palavecino, Germán Lobos, Tomás Cermenati, Jaime Poniachik
Management of gastrointestinal bleeding caused by fundal varices is particularly difficult to manage. The options are: transjugular intrahepatic portosystemic shunt (TIPS), endoscopic injection of cyanoacrylate or balloon-occluded retrograde transvenous obliteration (BRTO). We report a 63 year-old male with a cirrhosis caused by hepatitis C and a 66 year-old female with a cirrhosis caused by a non-alcoholic steatohepatitis. Both patients had a gastrointestinal bleeding caused by fundal varices and were treated with sclerotherapy with cyanoacrylate assisted with BRTO...
October 2017: Revista Médica de Chile
Rebecca Zener, Virginie Demers, Annie Bilodeau, Andrew J Benko, Robert J Abraham, Jason K Wong, John R Kachura
PURPOSE: To investigate the current status and evolution of both the interventional radiologist's role as a clinician and the practice of interventional radiology (IR) over the past decade in Canada. MATERIALS AND METHODS: In 2015, an online survey was e-mailed to 210 interventional radiologists, including all Canadian active members of the Canadian Interventional Radiology Association (CIRA) and nonmembers who attended CIRA's annual meeting. Comparisons were made between interventional radiologists in academic versus community practice...
February 23, 2018: Journal of Vascular and Interventional Radiology: JVIR
Y-H Li, Z-Y Xu, H-M Wu, L-H Yang, Y Xu, X-N Wu, Y-M Wan
AIM: To investigate the long-term shunt patency and overall survival of transjugular intrahepatic portosystemic shunt (TIPS) placement using covered stents with or without bare stents over a follow-up period up to 7 years. MATERIALS AND METHODS: A total of 154 patients undergoing TIPS placement were enrolled and analysed retrospectively. They were divided into two groups: those undergoing TIPS placement using covered with bare stents (group A, n=42) and those without bare stents (group B, n=112)...
February 20, 2018: Clinical Radiology
Jonel Trebicka
Does transjugular intrahepatic portosystemic shunt stent (TIPS) improve survival in a subgroup of patients? Yes. TIPS nearly halves portal pressure and increases the effective blood volume. In cases of acute variceal hemorrhage and with a high risk of treatment failure, defined as either hepatic venous pressure gradient higher than 20 mm Hg, Child B with active bleeding at the endoscopy, or Child C with less than 14 points, early or preemptive placement of TIPS (within 72 hours) improves survival. Also, in suitable patients with intractable or refractory ascites, TIPS improves survival if placed early in the course of treatment...
February 2018: Seminars in Liver Disease
Jonathan Merola, Brett E Fortune, Yanhong Deng, Maria Ciarleglio, Smbat Amirbekian, Noami Chaudhary, Alampady Shanbhogue, Rajasekhara Ayyagari, Manuel I Rodriguez-Davalos, Lewis Teperman, Hearns W Charles, Samuel H Sigal
BACKGROUND: Portal vein thrombosis (PVT) develops in cirrhotic patients because of stagnation of blood flow. Transjugular intrahepatic portosystemic shunt (TIPS) creates a low-resistance conduit that restores portal venous patency and blood flow. AIM: The effect of PVT on transplant-free survival in cirrhotic patients undergoing TIPS creation was evaluated. PATIENTS AND METHODS: A multicenter, retrospective cohort study of patients who underwent TIPS creation for cirrhotic portal hypertension was carried out...
February 16, 2018: European Journal of Gastroenterology & Hepatology
Xuefeng Luo, Xiaoze Wang, Jiaze Yu, Yongjun Zhu, Xiaotan Xi, Huaiyuan Ma, Li Yang
OBJECTIVES: The blind portal vein puncture remains the most challenging step during transjugular intrahepatic portosystemic shunt (TIPS) creation. We performed a prospective randomised clinical trial to compare three-dimensional (3D) roadmap with CO2 wedged hepatic vein portography for portal vein puncture guidance. METHODS: Between March 2017 and May 2017, 30 patients were enrolled and randomly allocated to the study group (3D roadmap) or the control group (CO2 wedged hepatic vein portography)...
February 19, 2018: European Radiology
Yindee Geeratikun, Hans Timmermans, Barry Uchida, Younes Jahangiri, Masahiro Horikawa, John A Kaufman, Khashayar Farsad
OBJECTIVE: The Viatorr stent-graft (W. L. Gore and Associates), specifically made for transjugular intrahepatic portosystemic shunt (TIPS) creation, has significantly improved TIPS patency compared with bare metal stents. Post-TIPS hepatic encephalopathy (HE), however, remains relatively common after TIPS creation. We describe a technique to secondarily restrict a Viatorr stent-graft to treat post-TIPS refractory HE and maintain use of the Viatorr device. CONCLUSION: We show a simple technique to modify the Viatorr stent-graft for TIPS reduction...
February 15, 2018: AJR. American Journal of Roentgenology
Nishtha Sanjay Nagral, Vijay Waman Dhakre, Nirzar Parikh, Shaji Marar
A 33-year-old man of a Middle Eastern origin presented to us with abdominal pain and distension secondary to refractory ascites of 1-month duration. The patient had a history of taking oral retinoic acid 25 mg for 4 months for mycosis fungoides. Investigations revealed thrombosis of hepatic veins with extensive thrombosis of the porto-mesenteric axis. A combination of transjugular intrahepatic portosystemic shunt, balloon angioplasty and thrombolysis with recombinant tissue plasminogen activator was successfully used to treat his condition...
February 5, 2018: BMJ Case Reports
Fanny Turon, Virginia Hernández-Gea, Juan Carlos García-Pagán
PURPOSE OF REVIEW: To describe portal vein thrombosis (PVT) in the setting of cirrhosis especially in relation to its potential impact on liver transplantation. In addition, the safety and efficacy of anticoagulation is reviewed. RECENT FINDINGS: PVT in cirrhosis occurs in up to 26% of patients awaiting liver transplantation. Different studies have suggested that PVT impacts negatively post-liver transplantation survival, particularly in first year post-liver transplantation and when PVT is complete involving the porto-mesenteric confluence and not allowing physiological anastomosis...
February 9, 2018: Current Opinion in Organ Transplantation
Anusha Shirwaikar Thomas, Jerry Estep, David W Victor
Transjugular intrahepatic portosystemic shunt (TIPS) is an attractive therapeutic option in cirrhotic patients with recurrent variceal bleeding refractory to medical and endoscopic therapy. There is little known about the use of TIPS in patients with left ventricular assist devices (LVAD). We describe a patient with a durable continuous-flow LVAD and concurrent decompensated cardiac cirrhosis who underwent successful TIPS placement for recurrent variceal bleeding. The patient has had no rebleeding or encephalopathy in >12 months since TIPS placement...
2018: ACG Case Reports Journal
Tingxue Song, Martin Rössle, Fuliang He, Fuquan Liu, Xiaozhong Guo, Xingshun Qi
BACKGROUND: Hepatorenal syndrome is a severe complication of advanced liver diseases with a dismal prognosis. AIMS: This systematic review and meta-analysis aims to explore the efficacy and safety of transjugular intrahepatic portosystemic shunt for the treatment of hepatorenal syndrome. METHOD: Publications were searched via PubMed and EMBASE databases. The pooled proportion and mean difference were calculated by using a random-effect model...
February 5, 2018: Digestive and Liver Disease
Michael Praktiknjo, Jennifer Lehmann, Mette J Nielsen, Robert Schierwagen, Frank E Uschner, Carsten Meyer, Daniel Thomas, Christian P Strassburg, Flemming Bendtsen, Søren Møller, Aleksander Krag, Morten A Karsdal, Diana J Leeming, Jonel Trebicka
Patients with end-stage liver disease develop acute decompensation (AD) episodes, which become more frequent and might develop into acute-on-chronic liver failure (ACLF). However, it remains unknown how AD induces acceleration of liver disease. We hypothesized that remodeling of collagen type III plays a role in the acceleration of liver cirrhosis after AD and analyzed its formation (Pro-C3) and degradation (matrix metalloproteinase-degraded type III collagen [C3M]) markers in animal models and human disease...
February 2018: Hepatology communications
Erin K Spengler, Lawrence G Hunsicker, Sanam Zarei, M Bridget Zimmerman, Michael D Voigt
Physicians often exclude patients with a model for end-stage liver disease (MELD) score ≥ 18 from a transjugular intrahepatic portosystemic shunt (TIPS) procedure due to the concern for higher risk of death. We aimed to determine if TIPS increased the risk of death in these patients. We analyzed the interaction between TIPS and MELD in 106 patients with TIPS and 79 with intractable ascites without TIPS. We performed Cox proportional hazard regression, including both TIPS and MELD as time-dependent covariates together with their interaction, to calculate the impact of TIPS on the risk of death associated with a high MELD score...
July 2017: Hepatology communications
Younes Jahangiri, Timothy Kerrigan, Lei Li, Dominik Prosser, Anantnoor Brar, Johnathan Righetti, Ryan C Schenning, John A Kaufman, Khashayar Farsad
Background: To identify risk factors of stent graft thrombosis after transjugular intrahepatic portosystemic shunt (TIPS) creation. Methods: Patients who underwent TIPS creation between June 2003 and January 2016 and with follow-up assessing stent graft patency were included (n=174). Baseline comorbidities, liver function, procedural details and follow-up liver function tests were analyzed in association with hazards of thrombosis on follow-up. Competing risk cox regression models were used considering liver transplant after TIPS creation as the competing risk variable...
December 2017: Cardiovascular Diagnosis and Therapy
Xiuli Yin, Xiaofei Lei, Changqing Xu, Jing Yang, Yingying Zhao, Kun Li
RATIONALE: Esophageal variceal bleeding caused by portal hypertension is massive and life-threatening to those patients with decompensated liver cirrhosis. A transjugular intrahepatic portosystemic shunt (TIPS) can effectively stop bleeding. But the process of puncture may lead to bile duct injury and even form fistulas between the hepatic artery and bile duct. PATIENT CONCERNS: The case report illustrated a 52-year-old Chinese female patient who underwent TIPS...
December 2017: Medicine (Baltimore)
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