Warfarin Reduces the Incidence of Portal Vein Thrombosis After Transjugular Intrahepatic Portosystemic Shunt: A Prospective Study
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Portal vein thrombosis
Portosystemic shunt
Abstract Portal vein thrombosis (PVT) is a heterogeneous condition with multiple possible etiologies and to varying degrees has historically limited candidacy for liver transplant (LT) in the cirrhotic patient population due to resultant difficulties in constructing a robust portal vein anastomosis. While intraoperative approaches to managing PVT are well-described, methods which approximate normal portal physiology are not always feasible depending on the extent of PVT, and other nonphysiologic techniques are linked with substantial morbidity and poor long-term outcomes. Portal vein recanalization–transjugular intrahepatic portosystemic shunt (PVR-TIPS) creation is an efficacious method of restoring physiologic portal flow in cirrhotic patients prior to LT allowing for end-to-end PV anastomosis, and is the product of decades-long institutional expertise in TIPS/LT and the support of a multidisciplinary liver tumor board. To follow is a review of the pertinent pathophysiology of PVT in cirrhosis, the rationale leading to the development and subsequent evolution of the PVR-TIPS procedure, technical lessons learned, and a summary of outcomes to date.
Portal vein thrombosis
Portosystemic shunt
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The transjugular intrahepatic portosystemic shunt (TIPS) is an acceptable procedure that has proven benefits in the treatment of patients who have complications from portal hypertension due to liver cirrhosis.Delayed liver laceration is a rare complication of the TIPS procedure.We describe a patient with portal hypertension due to liver cirrhosis, who suddenly presented with abdominal hemorrhage and liver laceration 8 d after TIPS.Few reports have described complications after TIPS placement.To the best of our knowledge, this is the first report describing delayed liver laceration.This potential and serious complication appears to be specific and fatal for TIPS in portal hypertension.We advocate careful attention to the technique to avoid this complication, and timely treatment is extremely important.
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The authors report on the group of 85 patients with portal hypertension in whom a portosystemic shunt was established for uncontrolled bleeding from varices--in the period from 1968 to 1993. A total lethality was 9.4%, in planned operations 5.9%, in acute interventions 22%. Some aspects of shunt-operation are discussed (prehepatic portal hypertension, acute shunt, shunt preceding liver transplantation). It is concluded that the portosystemic shunt still plays a role in the therapy of complicated portal hypertension, although only as a selective intervention.
Portosystemic shunt
Portacaval shunt
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Limiting
Portosystemic shunt
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Hydrothorax
Portosystemic shunt
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Transjugular intrahepatic portosystemic shunt (TIPS) is an artificially created conduit between the portal and systemic vascular system in the liver performed percutaneously via radiological guidance. It is used mainly in conditions causing portal hypertension and its resulting complications. It reduces portal pressure by diverting portal blood flow into the systemic circulation. Hepatic encephalopathy is the most common complication following TIPS insertion and tends to present fairly early. We describe a case of hepatic encephalopathy as an unusual late complication of TIPS insertion (first presenting six years after) for non-cirrhotic portal hypertension caused by nodular regenerative hyperplasia in an HIV-positive patient on highly active antiretroviral therapy.
Nodular regenerative hyperplasia
Hepatic Encephalopathy
Portosystemic shunt
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Grieco, Stefania MD; Sulekova, Lucia Fontanelli MD; Nardelli, Silvia MD; Riggio, Oliviero PhD; Venditti, Mario MD; Taliani, Gloria PhD Author Information
Portosystemic shunt
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Transjugular intrahepatic portosystemic shunt (TIPS) is an established intervention to treat complicated portal hypertension refractory to medical or endoscopic management. TIPS dysfunction results in the recurrence of portal hypertension symptoms. In cases of TIPS dysfunction or persistent portal hypertension despite a patent primary TIPS, the creation of parallel TIPS may be the only intervention to effectively reduce portal pressure. Since the introduction of dedicated TIPS stents (Viatorr®) the incidence of TIPS dysfunction has reduced profoundly. Nevertheless, the creation of a parallel TIPS can still be necessary in the current dedicated TIPS stent era.We report one such patient who experienced ongoing portal hypertension induced upper gastro-intestinal haemorrhage despite multiple TIPS revisions and a patent primary TIPS.Following creation of a parallel TIPS, the patient remains in clinical remission with no further bleeding.
Refractory (planetary science)
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Hepatic Encephalopathy
Portal hypertensive gastropathy
Liver disease
Gastrointestinal bleeding
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Portal hypertensive gastropathy
Hepatic Encephalopathy
Liver disease
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