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Transjugular intrahepatic portosystem

Peng Hu, Si-Liang Chen, Zhi-Peng Lin, Jian-Bo Zhao, Yong Chen, Xiao-Feng He, Qing-le Zeng, Yan-Hao Li
OBJECTIVE: To evaluate the effect of the length of covered stents in the portal and hepatic veins on long-term clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS). METHODS: We retrospectively reviewed 53 cases receiving TIPSs between January, 2008 and December, 2011. All the shunts were created with Fluency stents (8 mm in diameter). Bare metal grafts of the same diameter were implanted to extend the length in the portal and hepatic veins as deemed necessary according to angiographic images...
October 20, 2016: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
Ahmed Kamel Abdel-Aal, Nabila Dawoud, Amr Soliman Moustafa, Maysoon F Hamed, Souheil Saddekni
We report a case of 59-year-old female with non-alcoholic-steato-hepatitis (NASH) induced cirrhosis, who presented with hematochezia. The patient had a history of bleeding esophageal varices treated with endoscopic variceal ligation (EVL). Colonoscopy showed large rectal varices which were the source of her lower gastrointestinal bleeding (LGIB). Since endoscopic treatment for LGIB are limited, and because the patient had portal vein thrombosis which contraindicated transjugular intrahepatic portosystemic shunt (TIPS), we performed percutaneous transhepatic embolization of her rectal varices using a new mixture of embolic and sclerotic agents, followed by Amplatzer plug 2 (AVP 2)...
September 2016: Journal of Radiology Case Reports
Bart De Keyzer, Frederik Nevens, Annouschka Laenen, Sam Heye, Wim Laleman, Chris Verslype, Schalk van der Merwe, Geert Maleux
:  Background and rationale for the study. The purpose of this study was to assess the technical and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) reduction for the management of TIPS-induced acute liver decompensation. Between August 2000 and November 2013, 347 patients underwent a TIPS procedure in the authors' institution; 21/347 (6%) developed post-TIPS acute liver decompensation which was managed using a percutaneous shunt reduction technique. Patient demographics, laboratory tests before and after initial TIPS and TIPS reduction, procedural data and clinical follow-up data were analysed...
November 2016: Annals of Hepatology
Tea L Laursen, Sidsel Rødgaard-Hansen, Holger J Møller, Christian Mortensen, Stine Karlsen, Dennis T Nielsen, Susanne Frevert, Jens O Clemmesen, Søren Møller, Jørgen S Jensen, Flemming Bendtsen, Henning Grønbaek
BACKGROUND & AIMS: Intestinal bacterial translocation is involved in activation of liver macrophages in cirrhotic patients. Macrophages play a key role in liver inflammation and are involved in the pathogenesis of cirrhosis and complications. Bacterial translocation may be determined by presence of bacterial DNA and macrophage activation, by the soluble mannose receptor. We hypothesize that the soluble mannose receptor is released from hepatic macrophages in cirrhosis and associated with bacterial DNA, portal pressure and complications...
October 5, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
T Stuber, B Schmitz, H J Brambs
Introduction: Portal hypertension may lead to severe esophageal or rectal variceal bleeding. Case report: We present a case of a 67-year-old patient presenting with recurrent rectal variceal bleeding who was non-responsive to endoscopic treatment. We are reporting on an interventional therapeutic approach found in interdisciplinary consensus. Discussion: Endoscopy, surgery or TIPS (transjugular intrahepatic portosystemic shunt) can be performed in patients with gastrointestinal bleeding due to portal hypertension in liver cirrhosis...
October 5, 2016: Zeitschrift Für Gastroenterologie
M Buechter, J M Theysohn, A Kahraman, P Manka, G Gerken, A Canbay, A Dechêne
Background: Transjugular intrahepatic portosystemic shunt (TIPS) is considered the gold standard for treatment of gastrointestinal variceal bleeding refractory to endoscopic therapy in patients with portal hypertension. Clinically relevant hemorrhage from rectal varices is less frequent than from other sources, and the therapeutic role of TIPS is still ambiguous. Case report: A 57-year-old female patient was referred to us in December 2015 with severe signs of decompensated alcohol-induced liver cirrhosis. During hospitalization, she presented with recurrent hematochezia from rectal varices following electrosurgical snare removal of a rectal adenoma...
October 5, 2016: Zeitschrift Für Gastroenterologie
Luis Lizardo-Sanchez, James Burdick, James F Trotter
Gastric variceal bleeding is associated with significant morbidity and mortality in patients with portal hypertension and cirrhosis. Options are limited for patients who are not candidates for transjugular intrahepatic portosystemic shunts (TIPS). Cyanoacrylate injections have been reported to be efficacious in previous case series. The aim of this retrospective study was to report our single-center experience with the safety and efficacy of 2-octyl-cyanoacrylate in patients who were not TIPS candidates. Electronic medical records were reviewed for 16 patients who underwent a total of 18 esophagogastroduodenoscopies for acute gastric or duodenal variceal bleeding and secondary prophylaxis of gastric varices; 14 patients had cirrhosis with an average Model for End-Stage Liver Disease score of 16, and 2 patients had noncirrhotic portal hypertension...
October 2016: Proceedings of the Baylor University Medical Center
Kianoush Ansari-Gilani, Babak Seddigh Tonekaboni, Dean A Nakamoto, Jamak Modaresi Esfeh
OBJECTIVE: Portal pressure gradient (PPG) after transjugular intrahepatic portosystemic shunt (TIPS) <12 mmHg has been reported as the only factor predictive of increase in platelet count. As flow velocities measured on Doppler ultrasound are related to pressure gradient based on the Bernoulli equation, we used this parameter to predict increased platelet count after TIPS placement. METHODS: A total of 161 consecutive patients who underwent TIPS placement entered this retrospective study...
October 2, 2016: Gastroenterology Report
Adriana Cavași, Voicu Mercea, Ofelia Anton, Ion Cosmin Puia
Although transjugular intrahepatic portosystemic shunts are most frequently used for the management of portal hypertension, the surgical approach is preferred for symptomatic portal cavernoma cholangiopathy. We present the case of a 25-year old female patient with a portal cavernoma secondary to catheterization of the umbilical vein at birth. She had had two episodes of esophageal variceal bleeding, successfully treated by endoscopic banding. and an episode of acute cholangitis secondary to portal cavernoma cholangiopathy...
September 2016: Journal of Gastrointestinal and Liver Diseases: JGLD
Peter Isfort, Tobias Penzkofer, Christoph Wilkmann, Hong-Sik Na, Christian Kotzlowski, Nobutake Ito, Joachim Georg Pfeffer, Stefan Bisplinghoff, Sabine Osterhues, Andreas Besting, Jorge Gooding, Thomas Schmitz-Rode, Christiane Kuhl, Andreas Horst Mahnken, Philipp Bruners
OBJECTIVES: To develop an electromagnetic navigation technology for transjugular intrahepatic portosystemic shunt (TIPS) creation and translate it from phantom to an in-vivo large animal setting. MATERIAL AND METHODS: A custom-designed device for TIPS creation consisting of a stylet within a 5 French catheter as well as a software prototype were developed that allow real-time tip tracking of both stylet and catheter using an electromagnetic tracking system. Feasibility of navigated TIPSS creation was tested in a phantom by two interventional radiologists (A/B) followed by in-vivo testing evaluation in eight domestic pigs...
August 9, 2016: Minimally Invasive Therapy & Allied Technologies: MITAT
Mohammad S Khuroo, Ajaz A Rather, Naira S Khuroo, Mehnaaz S Khuroo
Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis...
September 21, 2016: World Journal of Gastroenterology: WJG
D Bettinger, M Schultheiss, T Boettler, M Muljono, R Thimme, M Rössle
BACKGROUND: The implantation of a transjugular intrahepatic portosystemic shunt (TIPSS) is a complex angiographic procedure performed in patients with end-stage liver disease. Numerous case reports and narrative reviews have been published so far; however, studies systematically investigating procedural and shunt-related complications are lacking. AIM: To systematically investigate complications and mortality occurring during the index hospital stay and the early (4-week) period after TIPSS implantation...
November 2016: Alimentary Pharmacology & Therapeutics
Maya Balakrishnan, Fernanda Souza, Carolina Muñoz, Salvador Augustin, Nicole Loo, Yanhong Deng, Maria Ciarleglio, Guadalupe Garcia-Tsao
OBJECTIVES: Measurements of liver stiffness and spleen stiffness are useful noninvasive ways to assess fibrosis and portal hypertension in patients with chronic liver disease. One method for assessing stiffness is by point shear wave elastography via acoustic radiation force impulse imaging (ARFI). Its advantage is that sites where stiffness is measured are visualized sonographically. However, its reliability has not been well established, and all studies done to date evaluating the use of ARFI in chronic liver disease have been performed outside the United States...
September 23, 2016: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Christophe Bureau, Dominique Thabut, Frédéric Oberti, Sébastien Dharancy, Nicolas Carbonell, Antoine Bouvier, Philippe Mathurin, Philippe Otal, Pauline Cabarrou, Jean Marie Péron, Jean Pierre Vinel
BACKGROUND & AIMS: There is controversy over the ability of transjugular intrahepatic portosystemic shunts (TIPS) to increase survival times of patients with cirrhosis and refractory ascites. The high rate of shunt dysfunction with the use of uncovered stents counteracts the benefits of TIPS. We performed a randomized controlled trial to determine the effects of TIPS with stents covered with polytetrafluoroethylene in these patients. METHODS: We performed a prospective study of 62 patients with cirrhosis and at least 2 large volume paracenteses within a period of at least 3 weeks; the study was performed at 4 tertiary care centers in France from August 2005 through December 2012...
September 20, 2016: Gastroenterology
Sofía Verdaguer D, Juan Cristóbal Gana A
BACKGROUND: There is a paucity of good quality research about the diagnosis of esophageal varices and the prophylaxis and treatment of variceal bleeding in pediatric patients with portal hypertension There is little consensus and practically no evidence-based approach about the management of these patients. AIM: To describe the behavior and preferences of pediatric gastroenterologists in Chile in the management of portal hypertension in children. MATERIAL AND METHODS: An online survey was sent to Chilean pediatric gastroenterologists, with questions evaluating the physicians’ approaches to screening of esophageal varices in children with portal hypertension, and their preferred methods of prophylaxis and initial management of variceal bleeding...
July 2016: Revista Médica de Chile
Barbara Geeroms, Wim Laleman, Annouschka Laenen, Sam Heye, Chris Verslype, Schalk van der Merwe, Frederik Nevens, Geert Maleux
PURPOSE: To retrospectively analyse long-term patency and overall survival of cirrhotic patients treated with TIPSS using e-PTFE-covered stents. Additionally, prognostic factors for better patency and survival were analysed. MATERIALS AND METHODS: Two hundred and eighty-five consecutive cirrhotic patients with severe portal hypertension-related symptoms were included. Follow-up, including clinical assessment and duplex ultrasound, was analysed up to end of study, patient's death, liver transplantation or TIPSS-reduction...
September 15, 2016: European Radiology
Basile Njei, Thomas R McCarty, Loren Laine
BACKGROUND AND AIM: Early transjugular intrahepatic portosystemic shunt (TIPS) used as preventive therapy prior to recurrent bleeding has been recommended in patients presenting with acute esophageal variceal bleeding (EVB) who are at high risk of further bleeding and death. We investigated the impact of early TIPS on outcomes of U.S. patients hospitalized with EVB from 2000 to 2010. METHODS: The Nationwide Inpatient Sample database was queried to identify patients with EVB and decompensated cirrhosis (because early TIPS is recommended only in high-risk patients)...
September 14, 2016: Journal of Gastroenterology and Hepatology
Mengfei Zhao, Zhendong Yue, Hongwei Zhao, Lei Wang, Zhenhua Fan, Fuliang He, Jiannan Yao, Xiaoqun Dong, Fuquan Liu
The patients of liver cirrhosis associated with portal vein thrombosis (PVT) can be effectively treated by transjugular intrahepatic portosystemic stent shunt (TIPS). Although the corresponding TIPS procedures have already performed on the patients to different types of PVT, the procedures are not specific and the relationship between different types of PVT and technical success rate of TIPS is unclear. What's more, we aimed to explore the relationship between survival and vascular patency immediately after TIPS...
2016: Scientific Reports
Jason T Salsamendi, Francisco J Gortes, Michelle Shnayder, Mehul H Doshi, Ji Fan, Govindarajan Narayanan
Portal vein thrombosis (PVT) is a potential complication of cirrhosis and can worsen outcomes after liver transplant (LT). Portal vein reconstruction-transjugular intrahepatic portosystemic shunt (PVR-TIPS) can restore flow through the portal vein (PV) and facilitate LT by avoiding complex vascular conduits. We present a case of transsplenic PVR-TIPS in the setting of complete PVT and splenic vein (SV) thrombosis. The patient had a 3-year history of PVT complicated by abdominal pain, ascites, and paraesophageal varices...
September 2016: Radiology case reports
Joshua M Owen, Ron Charles Gaba
OBJECTIVES: The objective of this study was to evaluate the concordance between clinical symptoms, Doppler ultrasound (US), and shunt venography for the detection of stent-graft transjugular intrahepatic portosystemic shunt (TIPS) dysfunction. MATERIALS AND METHODS: Forty-one patients (M:F 30:11, median age 55 years) who underwent contemporaneous clinical exam, Doppler US, and TIPS venography between 2003 and 2014 were retrospectively studied. Clinical symptoms (recurrent ascites or variceal bleeding) were dichotomously classified as present/absent, and US and TIPS venograms were categorized in a binary fashion as normal/abnormal...
2016: Journal of Clinical Imaging Science
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