[Transcaval transjugular intrahepatic portosystemic shunt: preliminary clinical results].
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传统的经颈内静脉穿刺门体分流术(TIPS)分流道是建立在肝静脉与门静脉分支之间的肝实质内[1],经过十年临床实践发现,在术中经肝静脉向门静脉穿刺不但常受肝尾叶肿瘤、肝静脉闭塞及肝静脉与门静脉之间的解剖关系的制约,而且术后的再狭窄常发生于支架肝静脉端,均与选择肝静脉有关.本研究探讨了经肝段下腔静脉直接穿刺门静脉建立TIPS分流道的安全性和可行性.Keywords:
Portosystemic shunt
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Portosystemic shunt
Lumen (anatomy)
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Background Transjugular intrahepatic portosystemic shunt (TIPS) creation is an accepted treatment of portal hypertension. Lower-extremity edema (LEE) is an underreported complication of TIPS creation. Purpose To assess the epidemiologic findings of LEE after TIPS creation and their association with patient survival. Materials and Methods The medical records of patients who underwent TIPS creation between January 2003 and April 2019 at Oregon Health and Science University and patients who underwent TIPS creation between January 2006 and December 2016 at University of Minnesota were retrospectively reviewed. Clinical, laboratory, and technical parameters, development and outcome of edema, and survival data were collected. LEE was defined as new-onset or worsened edema up to 1 year after TIPS creation. Cardiac ventricular function was evaluated with transthoracic echocardiography. Risk factors for LEE were evaluated with logistic regression analysis, and critical P values were additionally assessed by using the false discovery rate. Survival curves were compared by using the log-rank test. Results Three hundred thirty-four patients were included (mean age, 55 years ± 11 [standard deviation]; 208 men). TIPS creation was primarily performed for ascites (159 of 334 patients, 48%), gastrointestinal bleeding (127 of 334 patients, 38%), or a combination of bleeding and ascites (38 of 334 patients, 11%). One hundred seventy of the 334 patients (51%) developed LEE (new onset, 120; worsened edema, 50). Three of 170 patients (2%) had abnormal left ventricular ejection fraction. Multivariable analysis showed TIPS creation for ascites (odds ratio, 1.7; 95% CI: 1.04, 2.7; P = .03) and hepatic hydrothorax (odds ratio, 2.2; 95% CI: 1.1, 4.2; P = .02) was likely associated with LEE; however, it did not reach significance at a critical P value of .009. Among 164 patients with data on the outcome of LEE, LEE eventually improved in 94 (57%). The median survival of patients with LEE was lower than that of patients without LEE (38 months vs 71 months, respectively; P = .02). Conclusion Lower-extremity edema developed in more than 50% of study patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) creation, regardless of left ventricular function. There was suggestion that TIPS creation for ascites might be an underlying risk factor. Lower-extremity edema portends worse survival. © RSNA, 2020 Online supplemental material is available for this article.
Hydrothorax
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Log-rank test
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The purpose of the Journal of the Belgian Society of Radiology is the publication of articles dealing with diagnostic and interventional radiology, related imaging techniques, allied sciences, and continuing education
Portal vein thrombosis
Portosystemic shunt
Interventional radiology
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TIPS (transjugular intrahepatic portosystemic shunt) is a new interventional radiologic procedure that is useful in the treatment of variceal bleeding and ascites due to portal hypertension. It is most important that the shunt remains patent for a long time after placement. The potential role of ultrasound in evaluating the patency of the shunt after TIPS has been studied. Duplex and color doppler sonography were performed in 20 patients with portal hypertension after TIPS. Imaging was done in 38 case. The findings were compared with those of follow-up angiography. Shunt patency was evaluated with Doppler US in 28 case. In 27 of them, the equivalent patent shunt was confirmed by angiography; the exception was one case of occlusion in follow-up angiography. Doppler signals in the shunt could not be detected in 10 cases. Follow-up angiography showed occlusion in 7 cases and patency in the other 3. Doppler US sensitivity was 90%, and its specificity was 88%. These results indicate that Doppler US is one of the most useful methods for evaluating shunt patency after TIPS.
Doppler ultrasound
Portosystemic shunt
Portography
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Shunt dysfunction is a major complication of transjugular intrahepatic portosystemic shunt (TIPS). Ultrasonography is a preferred method of shunt follow-up after TIPS, but some misjudgments can occur in cases of shunt dysfunction due to peculiarities of the VIATORR stent. Here we report one case and suggest that the first ultrasound evaluation for patients who received TIPS procedure with VIATORR stent should be performed one month after the procedure.
Portosystemic shunt
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The transjugular intrahepatic portosystemic shunt (TIPS) is an effective and relatively safe and widely accepted treatment for complications arising from portal hypertension. Shunt or hepatic vein stenosis and shunt occlusion are common short- and medium-term complications arising from the procedure, though if detected early, these conditions may be treated before the recurrence of gastrointestinal bleeding or ascites. Doppler US is a relatively inexpensive, accurate, and noninvasive method for the evaluation of shunt status.
Portosystemic shunt
Color doppler
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April 1994Hepatic vein flow reversal at duplex sonography: a sign of transjugular intrahepatic portosystemic shunt dysfunction.Authors: V A Feldstein and J M LaBergeAuthor Info & AffiliationsVolume 162, Issue 4https://doi.org/10.2214/ajr.162.4.8141003 METRICS PDF
Portosystemic shunt
Duplex (building)
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Many patients with cirrhotic effusions in the peritoneal and pleural spaces lead a difficult existence. In addition to their decreased mobility and physical discomfort, they spend hours in the hospital or an outpatient facility undergoing peritoneal and pleural drainage. Liver transplantation is the ultimate solution for those with cirrhotic effusions refractory to medical management; however, most are on a long waiting list, forcing them to undergo a year or more of percutaneous centesis. Transjugular intrahepatic portosystemic shunts offer relief to those with cirrhotic ascites but at the cost of accelerated hepatic failure and hepatic encephalopathy. This article will review the development of the peritoneovenous and pleurovenous shunt, discuss reasons for its loss of favor, and suggest its current role in the armamentarium of the interventional radiologist.Peritoneovenous and pleurovenous shunt creation is a procedure that has the potential to significantly improve the quality of life of the patient by controlling the fluid collections, reducing dependence on frequent drainage procedures, improving renal function, and reducing protein loss.
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Transjugular intrahepatic portosystemic shunt (TIPSS) is considered a valid therapeutic option for the treatment of portal hypertension and its complications.The guidelines for this procedure have already been established on the basis of the normal vascular anatomy and of various technical radiological aspects.In some few rare cases, diagnosis of a congenital vascular anomaly can be made accidentally by interventional radiologists, making the procedure of the TIPSS placement extremely difficult or in some cases technically impossible.This report describes a rare vascular malformation characterized by the absence of the right superior vena cava and persistence of the left superior vena cava in a patient with a diagnosis of advanced liver cirrhosis who needed a TIPSS placement in order to control refractory ascites.
Vascular anomaly
Portosystemic shunt
Budd–Chiari syndrome
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Jugular vein
Portosystemic shunt
Hepatic portal vein
Internal jugular vein
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