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Interventional radiology in the management of portal hypertension.

Punamiya SJ - Indian J Radiol Imaging (2008)

Bottom Line: Various procedures are currently available, the choice depending on the etiology and location of disease, the pathoanatomy, and the symptomatology.The main aim of any procedure is to reduce the portal pressure by either direct or indirect methods.This can be achieved with transjugular intrahepatic portosystemic shunt (TIPS), recanalization of the hepatic vein outflow, recanalization of the portal vein and its tributaries, recanalization of dysfunctional portosystemic shunts, partial splenic embolization, and embolization of arterioportal shunts.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.

ABSTRACT
From being a mere (though important) diagnostic tool, radiology has evolved to become an integral part of therapy in portal hypertension today. Various procedures are currently available, the choice depending on the etiology and location of disease, the pathoanatomy, and the symptomatology. The main aim of any procedure is to reduce the portal pressure by either direct or indirect methods. This can be achieved with transjugular intrahepatic portosystemic shunt (TIPS), recanalization of the hepatic vein outflow, recanalization of the portal vein and its tributaries, recanalization of dysfunctional portosystemic shunts, partial splenic embolization, and embolization of arterioportal shunts. When any of these procedures cannot be performed due to anatomical or physiological reasons, the symptoms can often be controlled effectively with embolization of varices or balloon-occluded retrograde transvenous obliteration of varices (BRTO). This article briefly describes the procedures, their results, and their current status in the treatment of portal hypertension.

No MeSH data available.


Related in: MedlinePlus

TIPS performed in a patient with uncontrolled varicealbleed. Portal venogram (A) obtained after puncture of the portal vein shows retrograde filling of the left gastric vein and feeding of a large junctional varix. The portosystemic gradient was recorded at 21 mm Hg. The post-TIPS venogram (B) shows good flow across the TIPS. Adequate decompression is evident from the non-fi lling of the left gastric vein and varices and reduction of the portosystemic gradient to 4 mm Hg
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Figure 0001: TIPS performed in a patient with uncontrolled varicealbleed. Portal venogram (A) obtained after puncture of the portal vein shows retrograde filling of the left gastric vein and feeding of a large junctional varix. The portosystemic gradient was recorded at 21 mm Hg. The post-TIPS venogram (B) shows good flow across the TIPS. Adequate decompression is evident from the non-fi lling of the left gastric vein and varices and reduction of the portosystemic gradient to 4 mm Hg

Mentions: TIPS is a portosystemic shunt created within the liver parenchyma between the hepatic vein and the portal vein. The procedure involves many steps: (1) puncture of the jugular vein, (2) cannulation of the hepatic vein, (3) passage of a long needle from the hepatic vein, through the liver parenchyma and into the portal vein, (4) dilatation, with an angioplasty balloon, of the parenchymal tract created by the needle, and (5) stent deployment to ensure patency of the tract. Usually an 8-10 mm diameter stent is chosen to adequately decompress the hypertensive portal circulation to achieve a final portosystemic gradient of less than 12 mm Hg [Figure 1].


Interventional radiology in the management of portal hypertension.

Punamiya SJ - Indian J Radiol Imaging (2008)

TIPS performed in a patient with uncontrolled varicealbleed. Portal venogram (A) obtained after puncture of the portal vein shows retrograde filling of the left gastric vein and feeding of a large junctional varix. The portosystemic gradient was recorded at 21 mm Hg. The post-TIPS venogram (B) shows good flow across the TIPS. Adequate decompression is evident from the non-fi lling of the left gastric vein and varices and reduction of the portosystemic gradient to 4 mm Hg
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2747437&req=5

Figure 0001: TIPS performed in a patient with uncontrolled varicealbleed. Portal venogram (A) obtained after puncture of the portal vein shows retrograde filling of the left gastric vein and feeding of a large junctional varix. The portosystemic gradient was recorded at 21 mm Hg. The post-TIPS venogram (B) shows good flow across the TIPS. Adequate decompression is evident from the non-fi lling of the left gastric vein and varices and reduction of the portosystemic gradient to 4 mm Hg
Mentions: TIPS is a portosystemic shunt created within the liver parenchyma between the hepatic vein and the portal vein. The procedure involves many steps: (1) puncture of the jugular vein, (2) cannulation of the hepatic vein, (3) passage of a long needle from the hepatic vein, through the liver parenchyma and into the portal vein, (4) dilatation, with an angioplasty balloon, of the parenchymal tract created by the needle, and (5) stent deployment to ensure patency of the tract. Usually an 8-10 mm diameter stent is chosen to adequately decompress the hypertensive portal circulation to achieve a final portosystemic gradient of less than 12 mm Hg [Figure 1].

Bottom Line: Various procedures are currently available, the choice depending on the etiology and location of disease, the pathoanatomy, and the symptomatology.The main aim of any procedure is to reduce the portal pressure by either direct or indirect methods.This can be achieved with transjugular intrahepatic portosystemic shunt (TIPS), recanalization of the hepatic vein outflow, recanalization of the portal vein and its tributaries, recanalization of dysfunctional portosystemic shunts, partial splenic embolization, and embolization of arterioportal shunts.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.

ABSTRACT
From being a mere (though important) diagnostic tool, radiology has evolved to become an integral part of therapy in portal hypertension today. Various procedures are currently available, the choice depending on the etiology and location of disease, the pathoanatomy, and the symptomatology. The main aim of any procedure is to reduce the portal pressure by either direct or indirect methods. This can be achieved with transjugular intrahepatic portosystemic shunt (TIPS), recanalization of the hepatic vein outflow, recanalization of the portal vein and its tributaries, recanalization of dysfunctional portosystemic shunts, partial splenic embolization, and embolization of arterioportal shunts. When any of these procedures cannot be performed due to anatomical or physiological reasons, the symptoms can often be controlled effectively with embolization of varices or balloon-occluded retrograde transvenous obliteration of varices (BRTO). This article briefly describes the procedures, their results, and their current status in the treatment of portal hypertension.

No MeSH data available.


Related in: MedlinePlus