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A. Ochs - One of the best experts on this subject based on the ideXlab platform.
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The first decade of the transjugular intrahepatic Portosystemic shunt (TIPS) : state of the art
Liver, 2008Co-Authors: Martin Rössle, Volker Siegerstetter, Michael Huber, A. OchsAbstract:ABSTRACT— The transjugular intrahepatic Portosystemic shunt (TIPS) is an interventional treatment resulting in decompression of the portal system by creation of a side-to-side Portosystemic Anastomosis. Since its introduction 10 years ago, more than 500 publications have appeared demonstrating rapid acceptance and increasing clinical use. This review summarizes the present knowledge of technical aspects and complications, follow-up of patients, and indications. With respect to the technique, the TIPS procedure is probably one of the most difficult interventions and, therefore, technical success and complications clearly depend on the skills of the operator. Thus, the number and kind of complications reported in this review do not necessarily relate to the procedural complications of an experienced center. The follow-up of the TIPS patient has to assess shunt patency, liver function and hepatic encephalopathy. Shunt patency can best be monitored by duplex-sonography. Routine radiological revision seems not to be helpful and does not improve results, i.e., rebleeding and survival. Short term patency may be improved by anticoagulation, while such a treatment does not influence long-term patency. With respect to the indications of TIPS, much is known about treatment of variceal bleeding. The nine randomized studies that are available to date show that survival is comparable between patients receiving TIPS or endoscopic treatment. The second group of patients is the group with refractory ascites and related complications, such as hepatorenal syndrome and hepatic hydrothorax. It has been demonstrated that TIPS improves these complications, but randomized studies are still lacking. In addition, TIPS has been applied successfully to patients with Budd-Chiari syndrome, portal vein thrombosis, before liver transplantation, and for the treatment of ectopic portal hypertensive bleeding.
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Transjugular intrahepatic Portosystemic shunt.
Digestive Diseases, 2005Co-Authors: A. OchsAbstract:The transjugular intrahepatic Portosystemic shunt (TIPS) is an interventional treatment resulting in decompression of the portal system by creation of a side-to-side Portosystemic Anastomosis. Since i
Frysák Z - One of the best experts on this subject based on the ideXlab platform.
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Portosystemic Anastomosis at the time of transplantation and TIPS
Vnitr̆ní lékar̆ství, 1999Co-Authors: Jan Klein, Král, René Aujeský, Frysák ZAbstract:: Sclerotherapy has become in the treatment of acute haemorrhage of oesophageal varices the method of first choice. The relapse of haemorrhage within a five-year interval is however too frequent after this treatment. TIPS is a new method which can resolve profuse haemorrhage from varices in patients with a markedly reduced hepatic reserve. The high incidence of stenosis or occlusion (50% during the first six months) however foresees the use this method rather for bridging the interval before definite therapy i.e. transplantation of the liver. Patients with a sufficient functional hepatic reserve and those who are candidates for transplantation can be protected with a very good effect against relapsing haemorrhage by a surgical Anastomosis.
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Life prognosis in patients with prehepatic portal hypertension treated with Portosystemic shunts
Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti, 1991Co-Authors: Králík J, Seidlová Vl, Miroslav Myslivecek, Frysák ZAbstract:: The authors present the results of the long-term follow up of nine patients with prehepatic portal hypertension treated by a Portosystemic Anastomosis. The evaluation was made 5-21 years after operation, according to criteria focused on the therapeutic effect of the Anastomosis and its possible pathophysiological sequelae. In the authors' opinion the Anastomosis is the operation of choice suited for patients lacking a tendency of normalization of the portal circulation and with dangerous manifestations of portal overpressure. The indication is restricted to early age of the patients (for technical reasons). Conversely the patient should not attain adult age without unresolved hypertension. For correct timing of the operation knowledge of the development of the disease is essential. Primarily infact livers do not undergo pathological changes even after years of hypertension nor several years after an Anastomosis. This is consistent with the fact that these patients lack clinical manifestations of Portosystemic encephalopathy. Investigations of the course of flow curves during semiquantitative evaluation of hepatobiliary sequential scintigraphy supported the previous view that establishment of the Anastomosis and elimination of portal overpressure improves hepatic perfusion. Hepatobiliary sequential scintigraphy not previously used in this indication may be of value in the follow up of the disease and evidence of the Anastomosis. This preliminary conclusion is being tested in a prospective study.
Antonín Krajina - One of the best experts on this subject based on the ideXlab platform.
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Hepatic encephalopathy after TIPS--retrospective study
Vnitr̆ní lékar̆ství, 2002Co-Authors: Stefánková J, Antonín Krajina, Fejfar T, Safka, Fendrichová MAbstract:UNLABELLED: Hepatic encephalopathy (HE) is the main neuropsychiatric complication in cirrhosis of the liver. It develops slowly, begins by alteration of sleep and proceeds via flapping tremor to sopor, coma. Among known factors which promote its development are age, high dietary protein intake, haemorrhage into the GIT and the use of sedatives. Transjugular Portosystemic Anastomosis (TIPS) as a therapeutic method in complications of portal hypertension is associated with a higher incidence of HE. The objective of the work was to assess by retrospective investigations of patients with cirrhosis of the liver after TIPS the incidence of clinically significant HE and identify risk factors for the development of HE. MATERIAL AND METHODS: The group comprised 256 patients with cirrhosis of the liver after TIPS. This number included 59 diabetic and 197 non-diabetic patients, 7 patients suffered from chronic renal insufficiency and were in a regular dialyzation programme. The presence of HE was evaluated clinically. RESULTS: HE was found in 51% patients above 60 years of age, vs. 27% in younger patients (p = 0.002). The authors did not observe a difference in the incidence of HE in relation to sex, stage of cirrhosis, diameter of the stent nor the drop of the Portosystemic gradient. In diabetic patients HE developed in 45.8% (27 of 59), as compared with 30% (59 of 197) in non-diabetic patients (p = 0.02). Multivariance analysis revealed however that the group of diabetic patients had a higher average age and thus the incidence of HE was statistically significantly conditioned by age and not by the presence of diabetes. CONCLUSION: The risk group for HE in our patients were those above 60 years of age and patients with another than ethylic etiology of liver cirrhosis. There was no direct relationship between the development of HE and other investigated parameters. Although there was no difference in the incidence of HE in relation to the diameter of the inserted stent or Portosystemic gradient and its reduction, in case of unsuccessful conservative treatment with lactulose and diet, HE can be resolved by narrowing of the shunt by insertion of a reducing stent.
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Transjugular intrahepatic Portosystemic shunt (TIPS) in the treatment of symptomatic portal hypertension
Casopís lékar̆ů c̆eských, 1996Co-Authors: Antonín Krajina, Eliás P, Michl A, Jan Zizka, Nozicka J, Tomas Vanasek, Miroslav Lojík, I. Niangová, Volfová MAbstract:BACKGROUND: A transjugular intrahepatic Portosystemic shunt (TIPS) is the creation of a percutaneous Portosystemic Anastomosis which is used as an alternative method of surgical Portosystemic shunts and endoscopic treatment in the therapy of complications of portal hypertension. The objective of the present work was to summarize experience with TIPS in 100 patients. METHODS AND RESULTS: In 1992-1995 the authors treated 100 patients with symptomatic portal hypertension by TIPS. To create the shunt in 84% patients a spiral Z stent was used, in the remainder a Wallstent. In 86% patients the indication for TIPS was haemorrhage associated with portal hypertension and in 14% refractory ascites. TIPS was implemented in 98% patients. The pressure in the portal vela was not reduced on average to 58% of the original value. Haemorrhage was not stopped in one of 7 patients. Haemorrhage from varices reappeared in 7% patients indicated on account of repeated haemorrhage and was always associated with the finding of chronic stenosis of the shunt. The mortality in conjunction with the procedure was 4%, the mortality within 30 days after operation was 8%. Uncontrollable encephalopathy developed in 3% of the patients. Primary patency of the shunt created by the spiral Z stent was 85% after 6 months, after 12 months 72% and thus does not differ from primary patency when Wallstents are used, as reported in the literature. CONCLUSIONS: TIPS is an effective method to reduce the pressure in the portal vein in portal hypertension. The main limiting factor of the method is stenosis of the shunt due to hyperplasia of the neointima. Stenoses of the shunt can be effectively dilated by percutaneous balloon angioplasty.
Volfová M - One of the best experts on this subject based on the ideXlab platform.
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Transjugular intrahepatic Portosystemic shunt (TIPS) in the treatment of symptomatic portal hypertension
Casopís lékar̆ů c̆eských, 1996Co-Authors: Antonín Krajina, Eliás P, Michl A, Jan Zizka, Nozicka J, Tomas Vanasek, Miroslav Lojík, I. Niangová, Volfová MAbstract:BACKGROUND: A transjugular intrahepatic Portosystemic shunt (TIPS) is the creation of a percutaneous Portosystemic Anastomosis which is used as an alternative method of surgical Portosystemic shunts and endoscopic treatment in the therapy of complications of portal hypertension. The objective of the present work was to summarize experience with TIPS in 100 patients. METHODS AND RESULTS: In 1992-1995 the authors treated 100 patients with symptomatic portal hypertension by TIPS. To create the shunt in 84% patients a spiral Z stent was used, in the remainder a Wallstent. In 86% patients the indication for TIPS was haemorrhage associated with portal hypertension and in 14% refractory ascites. TIPS was implemented in 98% patients. The pressure in the portal vela was not reduced on average to 58% of the original value. Haemorrhage was not stopped in one of 7 patients. Haemorrhage from varices reappeared in 7% patients indicated on account of repeated haemorrhage and was always associated with the finding of chronic stenosis of the shunt. The mortality in conjunction with the procedure was 4%, the mortality within 30 days after operation was 8%. Uncontrollable encephalopathy developed in 3% of the patients. Primary patency of the shunt created by the spiral Z stent was 85% after 6 months, after 12 months 72% and thus does not differ from primary patency when Wallstents are used, as reported in the literature. CONCLUSIONS: TIPS is an effective method to reduce the pressure in the portal vein in portal hypertension. The main limiting factor of the method is stenosis of the shunt due to hyperplasia of the neointima. Stenoses of the shunt can be effectively dilated by percutaneous balloon angioplasty.
Martin Rössle - One of the best experts on this subject based on the ideXlab platform.
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The first decade of the transjugular intrahepatic Portosystemic shunt (TIPS) : state of the art
Liver, 2008Co-Authors: Martin Rössle, Volker Siegerstetter, Michael Huber, A. OchsAbstract:ABSTRACT— The transjugular intrahepatic Portosystemic shunt (TIPS) is an interventional treatment resulting in decompression of the portal system by creation of a side-to-side Portosystemic Anastomosis. Since its introduction 10 years ago, more than 500 publications have appeared demonstrating rapid acceptance and increasing clinical use. This review summarizes the present knowledge of technical aspects and complications, follow-up of patients, and indications. With respect to the technique, the TIPS procedure is probably one of the most difficult interventions and, therefore, technical success and complications clearly depend on the skills of the operator. Thus, the number and kind of complications reported in this review do not necessarily relate to the procedural complications of an experienced center. The follow-up of the TIPS patient has to assess shunt patency, liver function and hepatic encephalopathy. Shunt patency can best be monitored by duplex-sonography. Routine radiological revision seems not to be helpful and does not improve results, i.e., rebleeding and survival. Short term patency may be improved by anticoagulation, while such a treatment does not influence long-term patency. With respect to the indications of TIPS, much is known about treatment of variceal bleeding. The nine randomized studies that are available to date show that survival is comparable between patients receiving TIPS or endoscopic treatment. The second group of patients is the group with refractory ascites and related complications, such as hepatorenal syndrome and hepatic hydrothorax. It has been demonstrated that TIPS improves these complications, but randomized studies are still lacking. In addition, TIPS has been applied successfully to patients with Budd-Chiari syndrome, portal vein thrombosis, before liver transplantation, and for the treatment of ectopic portal hypertensive bleeding.