ABSTRACT
The transjugular intrahepatic portosystemic shunt (TIPS) is a percutaneous, minimally invasive method of creating a portosystemic shunt for the treatment of portal hypertension. These guidelines define indications and contraindications for referral of candidate patients to Danish TIPS-centres and are in accordance with international recommendations and local experience. TIPS will prevent re-bleeding from varices and decrease the need for repeated large volume paracentesis in patients with refractory ascites.
Subject(s)
Esophageal and Gastric Varices/surgery , Gastrointestinal Hemorrhage/surgery , Hypertension, Portal/surgery , Portasystemic Shunt, Transjugular Intrahepatic , Adult , Contraindications , Esophageal and Gastric Varices/complications , Esophageal and Gastric Varices/diagnosis , Gastrointestinal Hemorrhage/prevention & control , Humans , Hypertension, Portal/complications , Hypertension, Portal/diagnosis , Middle Aged , Patient Selection , Portasystemic Shunt, Transjugular Intrahepatic/adverse effects , Portasystemic Shunt, Transjugular Intrahepatic/methods , Practice Guidelines as Topic , Prognosis , RecurrenceABSTRACT
BACKGROUND: Portal vein thrombosis (PVT) is increasingly frequently being diagnosed, but systematic descriptions of the natural history and clinical handling of the condition are sparse. The aim of this retrospective study was to describe risk factors, clinical presentation, complications and treatment of portal vein thrombosis in a single-centre. METHODS: Sixty-seven patients were identified in the electronic records from 1992 to 2005. All data were obtained from the patient records. RESULTS: One or more risk factors (e.g. prothrombotic disorder or abdominal inflammation) were present in 87%. Symptoms were abdominalia, splenomegaly, fever, ascites, haematemesis, and weight loss. Abdominalia and fever occurred more frequently in patients with acute PVT. Frequent complications were splenomegaly, oesophageal- and gastric varices with or without bleeding, portal hypertensive gastropathy and ascites. Varices and bleeding were more frequent in patients with chronic PVT. Patients who received anticoagulant therapy more frequently achieved partial/complete recanalization. Patients with varices who were treated endoscopically in combination with beta-blockade had regression of the varices. The overall mortality was 13% in one year, and was dependent on underlying causes. CONCLUSION: Most patients had a combination of local and systemic risk factors for PVT. We observed that partial/complete recanalization was more frequent in patients treated with anticoagulation therapy, and that regression of varices was more pronounced in patients who where treated with active endoscopy combined with pharmacological treatment.
