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Digestive Disease Interventions 2023; 07(02): 081-088
DOI: 10.1055/s-0043-1761634
Review Article

Portal Vein Interventions for Portal Hypertension: Complications and Management

Paula M. Novelli 
1   Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Jason Polder
2   University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
,
Claire Kaufman
3   OHSU Dotter Interventional Institute, Portland, Oregon
,
Philip D. Orons
1   Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Abstract

Percutaneous management of complications of portal hypertension entails reducing portal pressures, controlling varices, and redirecting collateral flow using embolization, obliterative, restorative, recanalization, and shunt creation techniques. Management is based on the clinical status and symptoms and the physiologic and anatomic abnormalities causing portal hypertension. This article briefly describes percutaneous management strategies, their results, and related iatrogenic and physiologic complications.

Keywords

portal hypertension - transjugular intrahepatic portosystemic shunt - balloon-occluded retrograde transvenous obliteration - encephalopathy


Publikationsverlauf

Eingereicht: 16. Oktober 2022

Angenommen: 22. Dezember 2022

Artikel online veröffentlicht:
17. Februar 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2017; 65 (01) 310-335
    CrossrefPubMedSuche in Google Scholar
  • 2 Haskal ZJ. American Association for the Study of Liver Diseases practice guidelines: the role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Hepatology 2005; 41: 386-400
    CrossrefPubMedSuche in Google Scholar
  • 3 Dariushnia SR, Haskal ZJ, Midia M. et al; Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol 2016; 27 (01) 1-7
    CrossrefPubMedSuche in Google Scholar
  • 4 Haskal ZJ, Rees CR, Ring EJ, Saxon R, Sacks D. Society of Interventional Radiology Technology Assessment Committee. Reporting standards for transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol 2003; 14 (9, Pt 2): S419-S426
    CrossrefPubMedSuche in Google Scholar
  • 5 Patel IJ, Rahim S, Davidson JC. et al. Society of Interventional Radiology Consensus Guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions - Part II: Recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30 (08) 1168-1184.e1
    CrossrefPubMedSuche in Google Scholar
  • 6 Gordon AC, Saliken JC, Johns D, Owen R, Gray RR. US-guided puncture of the internal jugular vein: complications and anatomic considerations. J Vasc Interv Radiol 1998; 9 (02) 333-338
    CrossrefPubMedSuche in Google Scholar
  • 7 Pidlich J, Peck-Radosavljevic M, Kranz A. et al. Transjugular intrahepatic portosystemic shunt and cardiac arrhythmias. J Clin Gastroenterol 1998; 26 (01) 39-43
    CrossrefPubMedSuche in Google Scholar
  • 8 Fitt G, Thomson K, Hennessy O. Delayed fatal cardiac perforation by an indwelling long introducer sheath following transjugular intrahepatic portocaval stents (TIPS). Cardiovasc Intervent Radiol 1993; 16 (02) 109-110
    CrossrefPubMedSuche in Google Scholar
  • 9 Ripamonti R, Ferral H, Alonzo M, Patel NH. Transjugular intrahepatic portosystemic shunt-related complications and practical solutions. Semin Intervent Radiol 2006; 23 (02) 165-176
    Thieme ConnectPubMedSuche in Google Scholar
  • 10 Semba CP, Saperstein L, Nyman U, Dake MD. Hepatic laceration from wedged venography performed before transjugular intrahepatic portosystemic shunt placement. J Vasc Interv Radiol 1996; 7 (01) 143-146
    CrossrefPubMedSuche in Google Scholar
  • 11 Krajina A, Lojik M, Chovanec V, Raupach J, Hulek P. Wedged hepatic venography for targeting the portal vein during TIPS: comparison of carbon dioxide and iodinated contrast agents. Cardiovasc Intervent Radiol 2002; 25 (03) 171-175
    CrossrefPubMedSuche in Google Scholar
  • 12 Freedman AM, Sanyal AJ, Tisnado J. et al. Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review. Radiographics 1993; 13 (06) 1185-1210
    CrossrefPubMedSuche in Google Scholar
  • 13 Patel RK, Chandel K, Tripathy TP, Mukund A. Complications of transjugular intrahepatic portosystemic shunt (TIPS) in the era of the stent graft - What the interventionists need to know?. Eur J Radiol 2021; 144: 109986
    CrossrefPubMedSuche in Google Scholar
  • 14 Suhocki PV, Lungren MP, Kapoor B, Kim CY. Transjugular intrahepatic portosystemic shunt complications: prevention and management. Semin Intervent Radiol 2015; 32 (02) 123-132
    Thieme ConnectPubMedSuche in Google Scholar
  • 15 Kerlan Jr RK, LaBerge JM, Gordon RL, Ring EJ. Inadvertent catheterization of the hepatic artery during placement of transjugular intrahepatic portosystemic shunts. Radiology 1994; 193 (01) 273-276
    CrossrefPubMedSuche in Google Scholar
  • 16 Haskal ZJ, Cope C, Shlansky-Goldberg RD. et al. Transjugular intrahepatic portosystemic shunt-related arterial injuries: prospective comparison of large- and small-gauge needle systems. J Vasc Interv Radiol 1995; 6 (06) 911-915
    CrossrefPubMedSuche in Google Scholar
  • 17 Shah RP, Sze DY. Complications during transjugular intrahepatic portosystemic shunt creation. Tech Vasc Interv Radiol 2016; 19 (01) 61-73
    CrossrefPubMedSuche in Google Scholar
  • 18 Sze DY, Vestring T, Liddell RP. et al. Recurrent TIPS failure associated with biliary fistulae: treatment with PTFE-covered stents. Cardiovasc Intervent Radiol 1999; 22 (04) 298-304
    CrossrefPubMedSuche in Google Scholar
  • 19 Duller D, Kniepeiss D, Lackner C. et al. Biliary obstruction as a complication of transjugular intrahepatic portosystemic shunt. Liver Transpl 2009; 15 (05) 556-557
    CrossrefPubMedSuche in Google Scholar
  • 20 Hayashi PH, Mao J, Slater K. et al. Atrial septal perforation from TIPS stent migration. J Vasc Interv Radiol 2004; 15 (06) 629-632
    CrossrefPubMedSuche in Google Scholar
  • 21 Perarnau JM, Le Gouge A, Nicolas C. et al; STIC-TIPS Group. Covered vs. uncovered stents for transjugular intrahepatic portosystemic shunt: a randomized controlled trial. J Hepatol 2014; 60 (05) 962-968
    CrossrefPubMedSuche in Google Scholar
  • 22 Weber CN, Nadolski GJ, White SB. et al. Long-term patency and clinical analysis of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunt stent grafts. J Vasc Interv Radiol 2015; 26 (09) 1257-1265 , quiz 1265
    CrossrefPubMedSuche in Google Scholar
  • 23 Thurner A, Augustin AM, Götze O, Bley TA, Kickuth R. Percutaneous mechanical thrombectomy device assisted TIPS recanalization: a feasibility study. Acta Radiol 2022; 63 (09) 1196-1204
    CrossrefPubMedSuche in Google Scholar
  • 24 Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000; 31 (04) 864-871
    CrossrefPubMedSuche in Google Scholar
  • 25 Horhat A, Bureau C, Thabut D, Rudler M. Transjugular intrahepatic portosystemic shunt in patients with cirrhosis: indications and posttransjugular intrahepatic portosystemic shunt complications in 2020. United European Gastroenterol J 2021; 9 (02) 203-208
    CrossrefPubMedSuche in Google Scholar
  • 26 Salerno F, Merli M, Cazzaniga M. et al. MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol 2002; 36 (04) 494-500
    CrossrefPubMedSuche in Google Scholar
  • 27 Casadaban LC, Parvinian A, Zivin SP. et al. MELD score for prediction of survival after emergent TIPS for acute variceal hemorrhage: derivation and validation in a 101-patient cohort. Ann Hepatol 2015; 14 (03) 380-388
    CrossrefPubMedSuche in Google Scholar
  • 28 Adlakha N, Russo MW. Outcomes after transjugular intrahepatic portosystemic shunt in cirrhotic patients 70 years and older. J Clin Med 2020; 9 (02) 381
    CrossrefPubMedSuche in Google Scholar
  • 29 Rajesh S, George T, Philips CA. et al. Transjugular intrahepatic portosystemic shunt in cirrhosis: an exhaustive critical update. World J Gastroenterol 2020; 26 (37) 5561-5596
    CrossrefPubMedSuche in Google Scholar
  • 30 Riggio O, Angeloni S, Salvatori FM. et al. Incidence, natural history, and risk factors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stent grafts. Am J Gastroenterol 2008; 103 (11) 2738-2746
    CrossrefPubMedSuche in Google Scholar
  • 31 Bai M, Qi X, Yang Z. et al. Predictors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients: a systematic review. J Gastroenterol Hepatol 2011; 26 (06) 943-951
    CrossrefPubMedSuche in Google Scholar
  • 32 Casadaban LC, Parvinian A, Couture PM. et al. Characterization of liver function parameter alterations after transjugular intrahepatic portosystemic shunt creation and association with early mortality. AJR Am J Roentgenol 2014; 203 (06) 1363-1370
    CrossrefPubMedSuche in Google Scholar
  • 33 Gaba RC, Lakhoo J. What constitutes liver failure after transjugular intrahepatic portosystemic shunt creation? A proposed definition and grading system. Ann Hepatol 2016; 15 (02) 230-235
    PubMedSuche in Google Scholar
  • 34 Billey C, Billet S, Robic MA. et al. A prospective study identifying predictive factors of cardiac decompensation after transjugular intrahepatic portosystemic shunt: the Toulouse algorithm. Hepatology 2019; 70 (06) 1928-1941
    CrossrefPubMedSuche in Google Scholar
  • 35 Modha K, Kapoor B, Lopez R, Sands MJ, Carey W. Symptomatic heart failure after transjugular intrahepatic portosystemic shunt placement: incidence, outcomes, and predictors. Cardiovasc Intervent Radiol 2018; 41 (04) 564-571
    CrossrefPubMedSuche in Google Scholar
  • 36 Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 1992; 16 (06) 1343-1349
    CrossrefPubMedSuche in Google Scholar
  • 37 Hirota S, Matsumoto S, Tomita M, Sako M, Kono M. Retrograde transvenous obliteration of gastric varices. Radiology 1999; 211 (02) 349-356
    CrossrefPubMedSuche in Google Scholar
  • 38 Kitamoto M, Imamura M, Kamada K. et al. Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage. AJR Am J Roentgenol 2002; 178 (05) 1167-1174
    CrossrefPubMedSuche in Google Scholar
  • 39 Al-Osaimi AM, Sabri SS, Caldwell SH. Balloon-occluded retrograde transvenous obliteration (BRTO): preprocedural evaluation and imaging. Semin Intervent Radiol 2011; 28 (03) 288-295
    Thieme ConnectPubMedSuche in Google Scholar
  • 40 Lee EW, Saab S, Gomes AS. et al. Coil-assisted retrograde transvenous obliteration (CARTO) for the treatment of portal hypertensive variceal bleeding: preliminary results. Clin Transl Gastroenterol 2014; 5 (10) e61
    CrossrefPubMedSuche in Google Scholar
  • 41 Gwon DI, Ko GY, Yoon HK. et al. Gastric varices and hepatic encephalopathy: treatment with vascular plug and gelatin sponge-assisted retrograde transvenous obliteration – a primary report. Radiology 2013; 268 (01) 281-287
    CrossrefPubMedSuche in Google Scholar
  • 42 Saad WE, Sabri SS. Balloon-occluded retrograde transvenous obliteration (BRTO): technical results and outcomes. Semin Intervent Radiol 2011; 28 (03) 333-338
    Thieme ConnectPubMedSuche in Google Scholar