ABSTRACT
Objective: To compare the safety and efficacy of transmesenteric vein extrahepatic portosystemic shunt (TEPS) and transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of cavernous transformation of the portal vein (CTPV). Methods: The clinical data of CTPV patients with patency or partial patency of the superior mesenteric vein treated with TIPS or TEPS treatment in the Department of Vascular Surgery of Henan Provincial People's Hospital from January 2019 to December 2021 were selected. The differences in baseline data, surgical success rate, complication rate, incidence rate of hepatic encephalopathy, and other related indicators between TIPS and TEPS group were statistically analyzed by independent sample t-test, Mann-Whitney U test, and Chi-square test. Kaplan-Meier survival curve was used to calculate the cumulative patency rate of the shunt and the recurrence rate of postoperative portal hypertension symptoms in both groups. Results: The surgical success rate (100% vs. 65.52%), surgical complication rate (6.67% vs. 36.84%), cumulative shunt patency rate (100% vs. 70.70%), and cumulative symptom recurrence rate (0% vs. 25.71%) of the TEPS group and TIPS group were statistically significantly different (P < 0.05). The time of establishing the shunt [28 (2141) min vs. 82 (51206) min], the number of stents used [1 (12) vs. 2 (15)], and the length of the shunt [10 (912) cm vs. 16 (1220) cm] were statistically significant between the two groups (t = -3.764, -4.059, -1.765, P < 0.05). The incidence of postoperative hepatic encephalopathy in the TEPS group and TIPS group was 6.67% and 15.79% respectively, with no statistically significant difference (Fisher's exact probability method, P = 0.613). The pressure of superior mesenteric vein decreased from (29.33 ± 1.99) mmHg to (14.60 ± 2.80) mmHg in the TEPS group and from (29.68 ± 2.31) mmHg to (15.79 ± 3.01) mmHg in TIPS group after surgery, and the difference was statistically significant (t = 16.625, 15.959, P < 0.01). Conclusion: The best indication of TEPS is in CTPV patients with patency or partial patency of the superior mesenteric vein. TEPS improves the accuracy and success rate of surgery and reduces the incidence of complications.
Subject(s)
Humans , Portal Vein/surgery , Portasystemic Shunt, Transjugular Intrahepatic/methods , Hepatic Encephalopathy/etiology , Treatment Outcome , Hypertension, Portal/complications , Retrospective Studies , Gastrointestinal Hemorrhage/etiologyABSTRACT
BACKGROUND: Transjugular intrahepatic porto-systemic shunt (TIPS) for Budd-Chiari syndrome (BCS) can be inserted from inferior vena cava or hepatic vein to portal vein. The former is performed when hepatic veins are not suitable and is technically more challenging. METHODS: In this retrospective study, 7 patients with chronic BCS needed cavo-portal shunt as hepatic veins were neither amenable to plasty nor provided access for TIPS placement. Simultaneous fluoroscopic and trans-abdominal ultrasound guidance was used at the time of portal vein puncture. RESULTS: Technical success and clinical improvement were obtained in all patients. Median 3 (range 1-4) attempts were needed to puncture the portal vein. There were no significant complications. Uncovered stents were used in six patients and stent occlusion was common, but could be managed by re-intervention. CONCLUSION: Cavo-portal shunt is an effective technique for patients with BCS uncontrolled by medical therapy. Additional trans-abdominal ultrasound in oblique parasagittal plane keeps the procedure safe.
Subject(s)
Adult , Budd-Chiari Syndrome/diagnosis , Child , Female , Fluoroscopy , Hepatic Veins/diagnostic imaging , Humans , Male , Middle Aged , Portasystemic Shunt, Transjugular Intrahepatic/methods , Retrospective Studies , Treatment OutcomeABSTRACT
At the present time several therapeutic options are used for the treatment of bleeding esophageal varices in patients with portal hypertension. We will review the main medical publications on transjugular intrahepatic portosystemic shunt (TIPS), a procedure seldom used among us. TIPS works as a portocaval side-to-side shunt and decreases the risk of esophageal bleeding through lowering of the portal system pressure and a decrease of the portal hepatic pressure gradient. TIPS consists in the percutaneous insertion, through the internal jugular vein, of a metallic stent under fluoroscopic control in the hepatic parenchyma creating a true porta caval communication. There are several studies demonstrating the efficacy of TIPS, although only a few of them are randomized and control-matched to allow us to conclude that this procedure is safe, efficient and with a good cost benefit ratio. In this review, we search for the analysis of the TIPS utilization, its techniques, its major indications and complications. TIPS has been used in cases of gastroesophageal bleeding that has failed with pharmacologic or endoscopic treatment in patients Child-Pugh B and C. It can be used also as a bridge for liver transplantation. Others indications for TIPS are uncontrolled ascites, hepatic renal syndrome, and hepatic hydrothorax. The main early complications of TIPS using are related to the insertion site and hepatic encephalopathy and the stent occlusion is the chief late complication.
Subject(s)
Humans , Hypertension, Portal/therapy , Portasystemic Shunt, Transjugular Intrahepatic/standards , Ascites/complications , Ascites/therapy , Esophageal and Gastric Varices/complications , Gastrointestinal Hemorrhage/surgery , Hemodynamics , Hepatorenal Syndrome/etiology , Hepatorenal Syndrome/therapy , Hydrothorax/etiology , Hydrothorax/therapy , Hypertension, Portal/complications , Liver Cirrhosis/complications , Liver Transplantation , Portasystemic Shunt, Transjugular Intrahepatic/adverse effects , Portasystemic Shunt, Transjugular Intrahepatic , Portasystemic Shunt, Transjugular Intrahepatic/methodsABSTRACT
Los autores estudiaron 10 pacientes con hipertensión portal tratados con derivaciones portosistémicas por vía transyugular (TIPS) en los que evaluaron el flujo en el interior de la prótesis por medio de ultrasonido Doppler en color, Doppler de potencia y análisis espectral, antes y después de la aplicación de ecorrealzadores. Dos pacientes tuvieron flujos normales demostrados con el Doppler en color y con reconstrucciones en tercera dimensión. En seis pacientes encontraron signos de estenosis con reducción del flujo, uno en la porción proximal, tres en la porción media y dos en la distal; el empleo de ecorrealzadores en estos permitió mejorar el estudio del flujo y delimitar mejor el sitio y la morfología de la estenosis. En un paciente no se demostró flujo, debido a obstrucción.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Ultrasonics , Portasystemic Shunt, Transjugular Intrahepatic/methods , Esophageal and Gastric Varices/therapy , Hepatic Veins/pathologyABSTRACT
Approximately, 10 percent of cirrhotic patients with ascites become refractory to medical treatment, a condition that reduces overall survival. TIPS is a therapeutic alternative for the management of refractory ascites. It corrects sinusoidal portal hypertension, becoming a rational and relatively safe therapeutic approach. The most frequent complications of TIPS are the development of hepatic encephalopathy and a high incidence of shunt stenosis or occlusion after one year of follow-up. We report a 43 years old alcoholic cirrhotic male with ascites refractory to medical treatment, that required multiple large volume paracentesis, whose clinical condition deteriorated progressively. A TIPS was successfully placed with a rapid and complete resolution of ascites and marked improvement of his clinical condition. During the ensuing six months the patient remained in excellent conditions, but was lost from follow-up and resumed excessive alcohol intake. Eight months after TIPS placement he had an upper gastrointestinal bleeding and died
Subject(s)
Humans , Male , Adult , Ascites/surgery , Portasystemic Shunt, Transjugular Intrahepatic/methods , Ascites/diagnosis , Ascites/etiology , Portography , Treatment Outcome , Liver Cirrhosis, Alcoholic/complicationsABSTRACT
La hemorragia digestiva alta por varices esofágicas secundarias a hipertensión portal, sigue siendo un problema de dificil tratamiento. Han surgido diferentes alternativas para el control de la hipertensión portal. En este articulo se presenta una alternativa que, si bien no es nueva, ha tenido exito recientemente gracias al desarrollo de la protesis expandible de Palmaz que permite hacer una derivación portosistemica intrahepatica percutanea transyugular, con exito, manteniendo la permeabilidad y con buenos resultados hasta el momento. Se presenta un caso y se hace una revision de la literatura.