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Digestive Disease Interventions
DOI: 10.1055/s-0044-1782148
Review Article

TIPS and Interventional Radiology Management of Portal Hypertensive Complications in Pediatric Population

Dr. med. Jakob Spogis
1   Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
,
PD Dr. med. Ilias Tsiflikas
1   Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
,
Prof. Dr. med. Jürgen F. Schäfer
1   Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
,
Dr. med. Steffen Hartleif
2   Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital Tuebingen, Tuebingen, Germany
,
Prof. Dr. med. Steven W. Warmann
3   Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany
,
Prof. Dr. med. Gerd Grözinger
1   Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
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Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) placement is a well-established procedure for treating the sequelae of portal hypertension in adults. In pediatric patients also, TIPS is a good alternative to surgical shunt procedures because it is less invasive. However, similar or even more than in adults, TIPS creation is one of the technically more challenging procedures in children requiring special considerations regarding portal venous access and stent placement. Although data are limited to retrospective single-center experiences and meta-analysis, current findings suggest that TIPS is safe and effective in pediatric patients. If monitored and revised carefully, TIPS stents can last for a long time and may be able to serve for more than a short-term bridge to liver transplantation. This review shall provide information about the authors' procedural technique and give a short overview about the recent literature.

Keywords

TIPS - portal hypertension - interventional radiology


Publication History

Received: 10 January 2024

Accepted: 02 February 2024

Article published online:
14 March 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Garcia-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE, Glickman M. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology 1985; 5 (03) 419-424
    CrossrefPubMedGoogle Scholar
  • 2 Mileti E, Rosenthal P. Management of portal hypertension in children. Curr Gastroenterol Rep 2011; 13 (01) 10-16
    CrossrefPubMedGoogle Scholar
  • 3 Sarin SK, Sollano JD, Chawla YK. et al; Members of the APASL Working Party on Portal Hypertension. Consensus on extra-hepatic portal vein obstruction. Liver Int 2006; 26 (05) 512-519
    CrossrefPubMedGoogle Scholar
  • 4 Young V, Rajeswaran S. Management of portal hypertension in the pediatric population: a primer for the interventional radiologist. Semin Intervent Radiol 2018; 35 (03) 160-164
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Cortez AR, Kassam AF, Jenkins TM. et al. The role of surgical shunts in the treatment of pediatric portal hypertension. Surgery 2019; 166 (05) 907-913
    CrossrefPubMedGoogle Scholar
  • 6 Zielsdorf S, Narayanan L, Kantymyr S. et al. Surgical shunts for extrahepatic portal vein obstruction in pediatric patients: a systematic review. HPB (Oxford) 2021; 23 (05) 656-665
    CrossrefPubMedGoogle Scholar
  • 7 Raissi D, Brahmbhatt S, Yu Q, Jiang L, Liu C. Transjugular intrahepatic portosystemic shunt for pediatric portal hypertension: a meta-analysis. J Clin Imaging Sci 2023; 13: 18
    CrossrefPubMedGoogle Scholar
  • 8 García-Pagán JC, Caca K, Bureau C. et al; Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010; 362 (25) 2370-2379
    CrossrefPubMedGoogle Scholar
  • 9 Salerno F, Merli M, Riggio O. et al. Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites. Hepatology 2004; 40 (03) 629-635
    CrossrefPubMedGoogle Scholar
  • 10 Bureau C, Garcia Pagan JC, Layrargues GP. et al. Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomized multicentre study. Liver Int 2007; 27 (06) 742-747
    CrossrefPubMedGoogle Scholar
  • 11 Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases Practice Guidelines: the role of transjugular intrahepatic portosystemic shunt creation in the management of portal hypertension. J Vasc Interv Radiol 2005; 16 (05) 615-629
    CrossrefPubMedGoogle Scholar
  • 12 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
    CrossrefPubMedGoogle Scholar
  • 13 Islek A, Tumgor G. Acute-on-chronic liver failure in children. World J Hepatol 2021; 13 (10) 1289-1298
    CrossrefPubMedGoogle Scholar
  • 14 Bertino F, Hawkins CM, Shivaram G. et al. Technical feasibility and clinical effectiveness of transjugular intrahepatic portosystemic shunt creation in pediatric and adolescent patients. J Vasc Interv Radiol 2019; 30 (02) 178-186.e5
    CrossrefPubMedGoogle Scholar
  • 15 Ghannam JS, Cline MR, Hage AN. et al. Technical success and outcomes in pediatric patients undergoing transjugular intrahepatic portosystemic shunt placement: a 20-year experience. Pediatr Radiol 2019; 49 (01) 128-135
    CrossrefPubMedGoogle Scholar
  • 16 Johansen LC, McKiernan PJ, Sharif K, McGuirk SP. Transjugular intrahepatic portosystemic shunt insertion for the management of portal hypertension in children. J Pediatr Gastroenterol Nutr 2018; 67 (02) 173-179
    CrossrefPubMedGoogle Scholar
  • 17 Slowik V, Monroe EJ, Friedman SD, Hsu EK, Horslen S. Pressure gradients, laboratory changes, and outcomes with transjugular intrahepatic portosystemic shunts in pediatric portal hypertension. Pediatr Transplant 2019; 23 (03) e13387
    CrossrefPubMedGoogle Scholar
  • 18 Deniz S, Schinner R, Monroe EJ. et al. Outcome of children with transjugular intrahepatic portosystemic shunt: a meta-analysis of individual patient data. Cardiovasc Intervent Radiol 2023; 46 (09) 1203-1213
    CrossrefPubMedGoogle Scholar
  • 19 Wang Y, Ma B, Li P, Li W, Liu D. Feasibility and clinical effectiveness of transjugular intrahepatic portosystemic shunt creation in pediatric and adolescent patients: a meta-analysis. Pediatr Surg Int 2022; 38 (03) 377-387
    CrossrefPubMedGoogle Scholar
  • 20 Sanín E, Suárez-Galvis M, Álvarez S, Santamaría A. transjugular intrahepatic portosystemic shunt creation in children weighing <10 kg using an unconventional technique. J Vasc Interv Radiol 2023; 34 (06) 1070-1074
    CrossrefPubMedGoogle Scholar
  • 21 Partovi S, Li X, Shwaiki O. et al. Advanced portal venous access techniques for transjugular intrahepatic portosystemic shunt placement. BMJ Open Gastroenterol 2021; 8 (01) e000815
    CrossrefPubMedGoogle Scholar
  • 22 Jaber F, Beran A, Alsakarneh S. et al. Transjugular intrahepatic portosystemic shunt with or without gastroesophageal variceal embolization for the prevention of variceal rebleeding: a systematic review and meta-analysis. Gastroenterol Res 2023; 16 (02) 68-78
    CrossrefPubMedGoogle Scholar
  • 23 Wolter K, Praktiknjo M, Boie J. et al. Glue embolization of gastroesophageal varices during transjugular intrahepatic portosystemic shunt (TIPS) improves survival compared to coil-only embolization - a single-center retrospective study. Cardiovasc Intervent Radiol 2021; 44 (08) 1240-1250
    CrossrefPubMedGoogle Scholar
  • 24 Lautz TB, Kim ST, Donaldson JS, Superina RA. Outcomes of percutaneous interventions for managing stenosis after meso-Rex bypass for extrahepatic portal vein obstruction. J Vasc Interv Radiol 2012; 23 (03) 377-383
    CrossrefPubMedGoogle Scholar
  • 25 Shim DJ, Ko GY, Sung KB, Gwon DI, Ko HK. Long-term outcome of portal vein stent placement in pediatric liver transplant recipients: a comparison with balloon angioplasty. J Vasc Interv Radiol 2018; 29 (06) 800-808
    CrossrefPubMedGoogle Scholar
  • 26 Kim KS, Kim JM, Lee JS, Choi GS, Cho JW, Lee SK. Stent insertion and balloon angioplasty for portal vein stenosis after liver transplantation: long-term follow-up results. Diagn Interv Radiol 2019; 25 (03) 231-237
    CrossrefPubMedGoogle Scholar
  • 27 Ghibes P, Grözinger G, Hartleif S. et al. Balloon angioplasty versus stent placement for the treatment of portal vein stenosis in children: a single center experience. Pediatr Radiol 2023; 53 (09) 1885-1893
    CrossrefPubMedGoogle Scholar
  • 28 Lv Y, He C, Guo W. et al. Transjugular intrahepatic portosystemic shunt for extrahepatic portal venous obstruction in children. J Pediatr Gastroenterol Nutr 2016; 62 (02) 233-241
    CrossrefPubMedGoogle Scholar
  • 29 Hackworth CA, Leef JA, Rosenblum JD, Whitington PF, Millis JM, Alonso EM. Transjugular intrahepatic portosystemic shunt creation in children: initial clinical experience. Radiology 1998; 206 (01) 109-114
    CrossrefPubMedGoogle Scholar
  • 30 Samanta A, Sen Sarma M, Yadav R. Budd-Chiari syndrome in children: challenges and outcome. World J Hepatol 2023; 15 (11) 1174-1187
    CrossrefPubMedGoogle Scholar
  • 31 Rössle M. TIPS: 25 years later. J Hepatol 2013; 59 (05) 1081-1093
    CrossrefPubMedGoogle Scholar
  • 32 Sharma VK, Ranade PR, Marar S, Nabi F, Nagral A. Long-term clinical outcome of Budd-Chiari syndrome in children after radiological intervention. Eur J Gastroenterol Hepatol 2016; 28 (05) 567-575
    CrossrefPubMedGoogle Scholar
  • 33 Charon JP, Alaeddin FH, Pimpalwar SA. et al. Results of a retrospective multicenter trial of the Viatorr expanded polytetrafluoroethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt creation. J Vasc Interv Radiol 2004; 15 (11) 1219-1230
    CrossrefPubMedGoogle Scholar
  • 34 Lorenz JM. Placement of transjugular intrahepatic portosystemic shunts in children. Tech Vasc Interv Radiol 2008; 11 (04) 235-240
    CrossrefPubMedGoogle Scholar
  • 35 Di Giorgio A. et al Long-term outcome of transjugular intrahepatic portosystemic shunt in children with portal hypertension. J Pediatr Gastroenterol Nutr 2020; 70 (05) 615-622
    CrossrefPubMedGoogle Scholar
  • 36 Deswal S, Madhusudhan KS, Sharma S, Malik R. Balloon-occluded retrograde transvenous obliteration (BRTO): a treatment option in children with gastric varices. Indian J Pediatr 2020; 87 (12) 1078-1079
    CrossrefPubMedGoogle Scholar
  • 37 Saad WE, Anderson CL, Patel RS. et al. Management of gastric varices in the pediatric population with balloon-occluded retrograde transvenous obliteration (BRTO) utilizing sodium tetradecyl sulfate foam sclerosis with or without partial splenic artery embolization. Cardiovasc Intervent Radiol 2015; 38 (01) 236-241
    CrossrefPubMedGoogle Scholar
  • 38 Yamagami T, Yoshimatsu R, Kajiwara K, Onitake Y, Hiyama E, Awai K. Balloon-occluded retrograde transvenous obliteration successfully performed for a large gastric varix in combination with temporary occlusion of the splenic artery in a child. Acta Radiol Open 2015; 4 (03) 2047981614555141
    PubMedGoogle Scholar
  • 39 de Assis A, de Carvalho Melo Jr JA, Kawakami WY. et al. Life-threatening variceal bleeding after liver transplantation and extensive portal vein thrombosis: desperate times call for desperate measures. Pediatr Transplant 2023; 27 (08) e14555
    CrossrefPubMedGoogle Scholar