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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

Budd-Chiari syndrome secondary to diffuse hepatic vein occlusion, not amenable to angioplasty. The classical ‘spider-web’ appearance of small intrahepatic venous collaterals is seen with diffuse thrombosis of the hepatic veins (A); transcaval TIPS directly connecting the inferior vena cava and the portal vein, effectively decompresses the portal venous system (B)
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Figure 0006: Budd-Chiari syndrome secondary to diffuse hepatic vein occlusion, not amenable to angioplasty. The classical ‘spider-web’ appearance of small intrahepatic venous collaterals is seen with diffuse thrombosis of the hepatic veins (A); transcaval TIPS directly connecting the inferior vena cava and the portal vein, effectively decompresses the portal venous system (B)

Mentions: Budd-Chiari syndrome includes all obstructions to the hepatic vein outflow at the level of the hepatic vein and/or the inferior vena cava. This causes hepatic congestion which, when left untreated, progresses to hepatic necrosis and fibrosis. The aim of treatment is to restore physiological flow, i.e., to recanalize the hepatic vein and/or the inferior vena cava by balloon angioplasty and stenting thus relieving the hepatic congestion and preventing progression to irreversible liver damage.[27] This is feasible if the obstruction is over a short segment [Figures 4 and 5]. Long segment hepatic vein occlusion is difficult to reopen and even if restored the reocclusion rates are extremely high. This subgroup of patients would need a portosystemic shunt. Surgical portocaval shunts are difficult to create, due to the large caudate lobe not allowing easy access to the portal vein. Also, portocaval shunts may not be successful, as the shunt often opens into a hypertensive cava due to caval compression by an enlarged caudate lobe. TIPS has increasingly been performed in such patients as it is associated with much less morbidity and can provide very gratifying results [Figures 6 and 7]. In addition, TIPS opens high into the inferior vena cava and is not affected by any compression by the enlarged caudate lobe. In the few published case series, ascites control is close to 100%, and there is improvement in liver function, obviating the need for transplantation in most cases.[2829]


Interventional radiology in the management of portal hypertension.

Punamiya SJ - Indian J Radiol Imaging (2008)

Budd-Chiari syndrome secondary to diffuse hepatic vein occlusion, not amenable to angioplasty. The classical ‘spider-web’ appearance of small intrahepatic venous collaterals is seen with diffuse thrombosis of the hepatic veins (A); transcaval TIPS directly connecting the inferior vena cava and the portal vein, effectively decompresses the portal venous system (B)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0006: Budd-Chiari syndrome secondary to diffuse hepatic vein occlusion, not amenable to angioplasty. The classical ‘spider-web’ appearance of small intrahepatic venous collaterals is seen with diffuse thrombosis of the hepatic veins (A); transcaval TIPS directly connecting the inferior vena cava and the portal vein, effectively decompresses the portal venous system (B)
Mentions: Budd-Chiari syndrome includes all obstructions to the hepatic vein outflow at the level of the hepatic vein and/or the inferior vena cava. This causes hepatic congestion which, when left untreated, progresses to hepatic necrosis and fibrosis. The aim of treatment is to restore physiological flow, i.e., to recanalize the hepatic vein and/or the inferior vena cava by balloon angioplasty and stenting thus relieving the hepatic congestion and preventing progression to irreversible liver damage.[27] This is feasible if the obstruction is over a short segment [Figures 4 and 5]. Long segment hepatic vein occlusion is difficult to reopen and even if restored the reocclusion rates are extremely high. This subgroup of patients would need a portosystemic shunt. Surgical portocaval shunts are difficult to create, due to the large caudate lobe not allowing easy access to the portal vein. Also, portocaval shunts may not be successful, as the shunt often opens into a hypertensive cava due to caval compression by an enlarged caudate lobe. TIPS has increasingly been performed in such patients as it is associated with much less morbidity and can provide very gratifying results [Figures 6 and 7]. In addition, TIPS opens high into the inferior vena cava and is not affected by any compression by the enlarged caudate lobe. In the few published case series, ascites control is close to 100%, and there is improvement in liver function, obviating the need for transplantation in most cases.[2829]

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