An Algorithm for Management After Transjugular Intrahepatic Portosystemic Shunt Placement According to Clinical Manifestations

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• 作者：Seung Kwon Kim ; Bryan G. Belikoff ; Carlos J. Guevara…
• 关键词：Portosystemic shunt ; Portal hypertension ; Balloon occlusion ; Gastric varices
• 刊名：Digestive Diseases and Sciences
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：62
• 期：2
• 页码：305-318
• 全文大小：
• 刊物类别：Medicine
• 刊物主题：Gastroenterology; Hepatology; Oncology; Transplant Surgery; Biochemistry, general;
• 出版者：Springer US
• ISSN：1573-2568
• 卷排序：62

文摘

We propose an algorithm for management after transjugular intrahepatic portosystemic shunt (TIPS) placement according to clinical manifestations. For patients with an initial good clinical response, surveillance Doppler ultrasound is recommended to detect stenosis or occlusion. A TIPS revision can be performed using basic or advanced techniques to treat stenosis or occlusion. In patients with an initial poor clinical response, a TIPS venogram with pressure measurements should be performed to assess shunt patency. The creation of a parallel TIPS may also be required if the patient is symptomatic and the portal pressure remains high after TIPS revision. Additional procedures may also be necessary, such as peritoneovenous shunt (Denver shunt) placement for refractory ascites, tunneled pleural catheter for hepatic hydrothorax, and balloon-occluded retrograde transvenous obliteration procedure for gastric variceal bleeding. A TIPS reduction procedure can also be performed in patients with uncontrolled hepatic encephalopathy or hepatic failure.