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Transjugular intrahepatic portosystemic shunt for the treatment of portal hypertension in noncirrhotic patients with portal cavernoma.

Luo X, Nie L, Zhou B, Yao D, Ma H, Jiang M, Zhang H, Li X - Gastroenterol Res Pract (2014)

Bottom Line: In patients with successful shunt placement, the portal pressure gradient decreased from 25.8 ± 5.7 to 9.5 ± 4.2 mmHg (P < 0.001).The remaining nine patients maintained functioning shunts through their last evaluation.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Center of Interventional Radiology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan 610041, China.

ABSTRACT
Background. The purpose of this study was to evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) placement in the management of portal hypertension in noncirrhotic patients with portal cavernoma. Methods. We conducted a single institution retrospective analysis of 15 noncirrhotic patients with portal cavernoma treated with TIPS placement. 15 patients (4 women and 11 men) were evaluated via the technical success of TIPS placement, procedural complications, and follow-up shunt patency. Results. TIPS placement was technically successful in 11 out of 15 patients (73.3%). Procedure-related complications were limited to a single instance of hepatic encephalopathy in one patient. In patients with successful shunt placement, the portal pressure gradient decreased from 25.8 ± 5.7 to 9.5 ± 4.2 mmHg (P < 0.001). TIPS dysfunction occurred in two patients during a median follow-up time of 45.2 months. Revision was not performed in one patient due to inadequate inflow. The other patient died of massive gastrointestinal bleeding in a local hospital. The remaining nine patients maintained functioning shunts through their last evaluation. Conclusions. TIPS is a safe and effective therapeutic treatment for noncirrhotic patients with symptomatic portal hypertension secondary to portal cavernoma.

No MeSH data available.


Related in: MedlinePlus

TIPS placement and recanalization of a segmental occluded main portal vein in a 26-year-old man with portal cavernoma. (a-b) CT scan shows occlusion of the portal vein at the hepatic hilum and partial patent main portal vein. (c) Portal venogram following access into the portal venous system reveals occlusion of the main portal vein and numerous collateral veins around the hilum. (d) Final portography obtained after TIPS placement with the distal end of the stent into the main portal vein demonstrates a good backflow through the shunt.
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fig1: TIPS placement and recanalization of a segmental occluded main portal vein in a 26-year-old man with portal cavernoma. (a-b) CT scan shows occlusion of the portal vein at the hepatic hilum and partial patent main portal vein. (c) Portal venogram following access into the portal venous system reveals occlusion of the main portal vein and numerous collateral veins around the hilum. (d) Final portography obtained after TIPS placement with the distal end of the stent into the main portal vein demonstrates a good backflow through the shunt.

Mentions: TIPS placement was technically successful in 11 (73.3%) out of 15 patients. In cases 3, 12, and 14, although the intrahepatic portal vein was accessed, the guidewire could not be negotiated across the occluded MPV despite numerous attempts. In case 1, no patent intrahepatic portal vein was visualized during the procedure. In eight patients, single covered stent was placed. In other three patients, additional stents (bare stents in one patient and covered stents in two patients) were placed in a coaxial fashion to ensure sufficient shunt flow. 10 mm diameter stents were deployed in 9 patients (Figure 1); 8 mm diameter stents were deployed in 2 patients in a large collateral vein since recanalization of the MPV failed (Figure 2). The average PPG decreased from 25.8 ± 5.7 to 9.5 ± 4.2 mmHg following the procedure (P < 0.001). In two patients, coil embolization of residual large collateral varices was performed to increase shunt flow. All TIPS creation was performed via transjugular approach only; neither transhepatic nor transsplenic approaches were utilized in our series.


Transjugular intrahepatic portosystemic shunt for the treatment of portal hypertension in noncirrhotic patients with portal cavernoma.

Luo X, Nie L, Zhou B, Yao D, Ma H, Jiang M, Zhang H, Li X - Gastroenterol Res Pract (2014)

TIPS placement and recanalization of a segmental occluded main portal vein in a 26-year-old man with portal cavernoma. (a-b) CT scan shows occlusion of the portal vein at the hepatic hilum and partial patent main portal vein. (c) Portal venogram following access into the portal venous system reveals occlusion of the main portal vein and numerous collateral veins around the hilum. (d) Final portography obtained after TIPS placement with the distal end of the stent into the main portal vein demonstrates a good backflow through the shunt.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4020304&req=5

fig1: TIPS placement and recanalization of a segmental occluded main portal vein in a 26-year-old man with portal cavernoma. (a-b) CT scan shows occlusion of the portal vein at the hepatic hilum and partial patent main portal vein. (c) Portal venogram following access into the portal venous system reveals occlusion of the main portal vein and numerous collateral veins around the hilum. (d) Final portography obtained after TIPS placement with the distal end of the stent into the main portal vein demonstrates a good backflow through the shunt.
Mentions: TIPS placement was technically successful in 11 (73.3%) out of 15 patients. In cases 3, 12, and 14, although the intrahepatic portal vein was accessed, the guidewire could not be negotiated across the occluded MPV despite numerous attempts. In case 1, no patent intrahepatic portal vein was visualized during the procedure. In eight patients, single covered stent was placed. In other three patients, additional stents (bare stents in one patient and covered stents in two patients) were placed in a coaxial fashion to ensure sufficient shunt flow. 10 mm diameter stents were deployed in 9 patients (Figure 1); 8 mm diameter stents were deployed in 2 patients in a large collateral vein since recanalization of the MPV failed (Figure 2). The average PPG decreased from 25.8 ± 5.7 to 9.5 ± 4.2 mmHg following the procedure (P < 0.001). In two patients, coil embolization of residual large collateral varices was performed to increase shunt flow. All TIPS creation was performed via transjugular approach only; neither transhepatic nor transsplenic approaches were utilized in our series.

Bottom Line: In patients with successful shunt placement, the portal pressure gradient decreased from 25.8 ± 5.7 to 9.5 ± 4.2 mmHg (P < 0.001).The remaining nine patients maintained functioning shunts through their last evaluation.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Center of Interventional Radiology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan 610041, China.

ABSTRACT
Background. The purpose of this study was to evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) placement in the management of portal hypertension in noncirrhotic patients with portal cavernoma. Methods. We conducted a single institution retrospective analysis of 15 noncirrhotic patients with portal cavernoma treated with TIPS placement. 15 patients (4 women and 11 men) were evaluated via the technical success of TIPS placement, procedural complications, and follow-up shunt patency. Results. TIPS placement was technically successful in 11 out of 15 patients (73.3%). Procedure-related complications were limited to a single instance of hepatic encephalopathy in one patient. In patients with successful shunt placement, the portal pressure gradient decreased from 25.8 ± 5.7 to 9.5 ± 4.2 mmHg (P < 0.001). TIPS dysfunction occurred in two patients during a median follow-up time of 45.2 months. Revision was not performed in one patient due to inadequate inflow. The other patient died of massive gastrointestinal bleeding in a local hospital. The remaining nine patients maintained functioning shunts through their last evaluation. Conclusions. TIPS is a safe and effective therapeutic treatment for noncirrhotic patients with symptomatic portal hypertension secondary to portal cavernoma.

No MeSH data available.


Related in: MedlinePlus