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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

Large duodenal varices due to focal occlusion of the superior mesenteric vein (SMV), causing recurrent malena. After percutaneous transhepatic access to the portal vein (A), a catheter is advanced into the SMV. The venogram shows occlusion of the SMV, with filling of the duodenal variceal collaterals; the occluded segment is dilated and a stent deployed, following which there is direct flow from the SMV into the portal vein and no filling of the duodenal varices (B)
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Figure 0008: Large duodenal varices due to focal occlusion of the superior mesenteric vein (SMV), causing recurrent malena. After percutaneous transhepatic access to the portal vein (A), a catheter is advanced into the SMV. The venogram shows occlusion of the SMV, with filling of the duodenal variceal collaterals; the occluded segment is dilated and a stent deployed, following which there is direct flow from the SMV into the portal vein and no filling of the duodenal varices (B)

Mentions: Extrahepatic obstruction of the portal vein or its branches can induce a focal PHT; this accounts for 5-10% of all cases of PHT. The cause of obstruction can be benign or malignant, and patients usually present with variceal bleeding, ascites, or abdominal pain. Recanalization of the blocked vein by angioplasty and stenting will reduce these symptoms and can be done either via a transjugular or a percutaneous transhepatic route [Figure 8].[3031]


Interventional radiology in the management of portal hypertension.

Punamiya SJ - Indian J Radiol Imaging (2008)

Large duodenal varices due to focal occlusion of the superior mesenteric vein (SMV), causing recurrent malena. After percutaneous transhepatic access to the portal vein (A), a catheter is advanced into the SMV. The venogram shows occlusion of the SMV, with filling of the duodenal variceal collaterals; the occluded segment is dilated and a stent deployed, following which there is direct flow from the SMV into the portal vein and no filling of the duodenal varices (B)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0008: Large duodenal varices due to focal occlusion of the superior mesenteric vein (SMV), causing recurrent malena. After percutaneous transhepatic access to the portal vein (A), a catheter is advanced into the SMV. The venogram shows occlusion of the SMV, with filling of the duodenal variceal collaterals; the occluded segment is dilated and a stent deployed, following which there is direct flow from the SMV into the portal vein and no filling of the duodenal varices (B)
Mentions: Extrahepatic obstruction of the portal vein or its branches can induce a focal PHT; this accounts for 5-10% of all cases of PHT. The cause of obstruction can be benign or malignant, and patients usually present with variceal bleeding, ascites, or abdominal pain. Recanalization of the blocked vein by angioplasty and stenting will reduce these symptoms and can be done either via a transjugular or a percutaneous transhepatic route [Figure 8].[3031]

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