4,013 results match your criteria Transjugular Intrahepatic Portosystemic Shunt


Proton pump inhibitor use is associated with increased rates of post-TIPS hepatic encephalopathy: Replication in an independent patient cohort.

Clin Imaging 2021 Apr 29;77:187-192. Epub 2021 Apr 29.

Division of Vascular & Interventional Radiology, Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC 27710, USA. Electronic address:

Purpose: Proton pump inhibitor (PPI) use is a potential risk factor for hepatic encephalopathy (HE), but few studies have examined the effect on post-TIPS HE. The purpose of this study was to determine whether PPIs are associated with increased rates of post-TIPS HE in an independent patient cohort.

Materials And Methods: This single-institution retrospective study analyzed 86 patients (54 male, mean age 58. Read More

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DIPS, a safe and effective alternative in patients with unfavorable anatomy to TIPSS: first experience in a tertiary center.

Clin Res Hepatol Gastroenterol 2021 Apr 27:101715. Epub 2021 Apr 27.

Service de gastroentérologie et d'hépatologie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Vaud, Suisse.

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External validation of the freiburg index of post-TIPS survival.

J Hepatol 2021 Apr 26. Epub 2021 Apr 26.

Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.

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Halting the haematochezia.

Frontline Gastroenterol 2021 15;12(3):232-234. Epub 2020 May 15.

Department of Gastroenterology and Hepatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.

An elderly gentleman with primary sclerosing cholangitis (PSC) was admitted with rectal bleeding, shown on flexible sigmoidoscopy to be arising from rectal varices, which bled despite endoscopic therapy with histoacryl glue. Therapeutic options were limited with surgery and transjugular intrahepatic portosystemic shunt deemed too high risk, and endovascular embolisation through interventional radiology was sought. Coil-assisted retrograde transvenous obliteration was used to good effect. Read More

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Ethnoracial disparity in hospital survival following transjugular intrahepatic portosystemic shunt creation for acute variceal bleeding in the United States.

J Vasc Interv Radiol 2021 Apr 23. Epub 2021 Apr 23.

Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora CO; Department of Radiology, University of Southern California.

Purpose: To investigate the magnitude of racial/ethnic differences in hospital mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation for acute variceal bleeding and whether hospital care processes contribute to them.

Methods: Patients >18 years undergoing TIPS creation for acute variceal bleeding in the United States (n=10,331) were identified in the 10 available years (2007-2016) of the National Inpatient Sample. Hierarchical logistic regression was used to examine the relationship between patient race and inpatient mortality, controlling for disease severity, treatment utilization and hospital characteristics. Read More

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Drug-eluting beads TACE is safe and non-inferior to conventional TACE in HCC patients with TIPS.

Eur Radiol 2021 Apr 24. Epub 2021 Apr 24.

Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China.

Objectives: This study aims to compare the safety and effectiveness between transarterial chemoembolization (TACE) with drug-eluting beads (DEB-TACE) and conventional TACE (cTACE) using lipiodol-based regimens in HCC patients with a transjugular intrahepatic portosystemic shunt (TIPS).

Methods: This retrospective study included patients with patent TIPS who underwent TACE from January 2013 to January 2019 that received either DEB-TACE (DEB-TACE group, n = 57) or cTACE (cTACE group, n = 62). The complications, liver toxicity, overall survival (OS), time to progression (TTP), and objective response rate (ORR) were compared between the groups. Read More

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Transjugular Intrahepatic Portosystemic Shunt Creation for Treatment of Gastric Varices: Systematic Literature Review and Meta-Analysis of Clinical Outcomes.

Cardiovasc Intervent Radiol 2021 Apr 22. Epub 2021 Apr 22.

Department of Radiology, College of Medicine University of Illinois at Chicago, MC 931, 1740 West Taylor Street, Chicago, IL, 60612, USA.

Purpose: To quantify the pooled clinical outcomes of stent-graft transjugular intrahepatic portosystemic shunt (TIPS) creation for the management of gastric varices (GVs) through systematic review of the literature and meta-analysis.

Materials And Methods: A PubMed and Embase search was performed from 2003 to 2020. Search terms included: (transjugular intrahepatic portosystemic shunt OR TIPS) AND (gastric varices OR fundal varices OR gastroesophageal varices OR gastroesophageal varices) AND (hemorrhage OR rebleeding OR rebleeding OR survival). Read More

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Acute Tension Hydrothorax in a Cirrhotic Patient With Hepatic Hydrothorax Without Ascites.

Cureus 2021 Mar 17;13(3):e13941. Epub 2021 Mar 17.

Internal Medicine, Rutgers New Jersey Medical School, Newark, USA.

We describe a case of a 50-year-old man with alcohol cirrhosis status post transjugular intrahepatic portosystemic shunt (TIPS) who presented with dyspnea, refractory hepatic hydrothorax (HH), and no ascites who subsequently developed acute tension hydrothorax (TH). Urgent ultrasound-guided thoracentesis was performed with a significant improvement of symptoms. Further management consisted of a chest tube placement, subsequently removed with a plan for intermittent thoracentesis as needed, diuretic therapy, and salt restriction. Read More

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Transjugular intrahepatic portosystemic shunt in refractory ascites: clinical impact of left ventricular diastolic dysfunction.

Eur J Gastroenterol Hepatol 2021 Apr 16. Epub 2021 Apr 16.

Division of Gastroenterology Cardiology Unit Interventional Radiology Unit, San Giovanni Battista Hospital, Turin, Italy.

Background And Aims: Left ventricular diastolic dysfunction (LVDD) in cirrhotics are associated with circulatory dysfunction, hepatorenal syndrome (HRS) and heart failure in stressful conditions. Transjugular intrahepatic portosystemic shunt (TIPS) exacerbates the hyperdynamic circulation and challenges cardiac function. We evaluated the incidence and the impact of LVDD in cirrhotic candidates to TIPS for refractory ascites. Read More

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Transjugular intrahepatic portosystemic shunt creation for the prevention of gastric variceal rebleeding in patients with hepatocellular carcinoma: a multicenter retrospective study.

J Vasc Interv Radiol 2021 Apr 14. Epub 2021 Apr 14.

Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address:

Purpose: To evaluate the effectiveness and safety of transjugular intrahepatic portosystemic shunt (TIPS) creation for the prevention of gastric variceal rebleeding in patients with Hepatocellular carcinoma (HCC).

Materials And Methods: This multicenter retrospective study included 126 cirrhotic patients (mean age, 54.1 ± 10. Read More

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Therapeutic strategies for refractory variceal bleeding due to percutaneous liver biopsy: A case report.

Int J Surg Case Rep 2021 Apr 7;82:105852. Epub 2021 Apr 7.

Donald Gordon Medical Centre, University of the Witwatersrand, South Africa. Electronic address:

Introduction And Importance: Variceal bleeding due to intrahepatic arterioportal fistula is an unusual complication of percutaneous liver biopsy. As majority of variceal bleeding are cirrhotic in origin, the rare occurrence of an acquired intrahepatic arterioportal fistula presents a therapeutic dilemma.

Case Presentation: We report the case of a 57-year-old female with refractory variceal bleeding that occurred six years after a percutaneous liver biopsy. Read More

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Prognostic Value of the CLIF-C AD Score in Patients With Implantation of Transjugular Intrahepatic Portosystemic Shunt.

Hepatol Commun 2021 Apr 5;5(4):650-660. Epub 2021 Jan 5.

Department of Medicine II Medical Center University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany.

Prognostic assessment of patients with liver cirrhosis allocated for implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is a challenging task in clinical practice. The aim of our study was to assess the prognostic value of the CLIF-C AD (Acute Decompensation) score in patients with TIPS implantation. Transplant-free survival (TFS) and 3-month mortality were reviewed in 880 patients who received TIPS implantation for the treatment of cirrhotic portal hypertension. Read More

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Current Concepts of Cirrhotic Cardiomyopathy.

Clin Liver Dis 2021 May 10;25(2):471-481. Epub 2021 Mar 10.

Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 North St Clair, Suite 1400, Chicago, IL 60611, USA; Department of Preventive Medicine, Division of Epidemiology, Northwestern University Feinberg School of Medicine, 676 North St Clair, Suite 1400, Chicago, IL 60611, USA.

Cirrhotic cardiomyopathy (CCM) connotes systolic and/or diastolic dysfunction in patients with end-stage liver disease in the absence of prior heart disease. Its prevalence is variable across different studies but recent data suggest that CCM may affect up to one third of liver transplant candidates. The etiology of CCM is multifactorial. Read More

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Management of Severe and Refractory Ascites.

Clin Liver Dis 2021 May 11;25(2):431-440. Epub 2021 Mar 11.

Service d'Hépatologie Hôpital Rangueil 1, Avenue Jean Poulhès CHU Toulouse France and Université Toulouse III-Paul Sabatier, France 31400. Electronic address:

Considering the poor prognosis, severe and refractory ascites is a milestone in cirrhotic patients. Liver transplantation must be considered first. In the case of contraindication to liver transplantation or when the waiting period is estimated to be more than 6 months, transjugular intrahepatic portosystemic shunt should be discussed in eligible patients. Read More

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Diagnosis and Management of Hepatic Encephalopathy.

Clin Liver Dis 2021 May 11;25(2):393-417. Epub 2021 Mar 11.

Brain Liver Salpêtrière Study Group, Sorbonne Université, INSERM UMR_S 938, Centre de Recherche Saint-Antoine & Institute of Cardiometabolism and Nutrition (ICAN), Paris 75013, France; AP-HP, Sorbonne Université, Liver Intensive Care Unit, Hepatogastroenterology Department, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, Paris 75013, France; Sorbonne Université, Paris F-75005, France. Electronic address:

Hepatic encephalopathy (HE) is a severe complication of cirrhosis. The prevalence of overt HE (OHE) ranges from 30% to 45%, whereas the prevalence of minimal HE (MHE) is as high as 85% in some case series. Widespread use of transjugular intrahepatic portosystemic shunt to control complications related to portal hypertension is associated with an increase in HE incidence. Read More

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Treatment of Acute Variceal Bleeding in 2021-When to Use Transjugular Intrahepatic Portosystemic Shunts?

Clin Liver Dis 2021 May 11;25(2):345-356. Epub 2021 Mar 11.

Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, Barcelona 08036, Spain; CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), HealthCare Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver). Electronic address:

Variceal bleeding in patients with cirrhosis is associated with high mortality if not adequately managed. Treatment of acute variceal bleeding with adequate resuscitation maneuvers, restrictive transfusion policy, antibiotic prophylaxis, pharmacologic therapy, and endoscopic therapy is highly effective at controlling bleeding and preventing death. There is a subgroup of high-risk cirrhotic patients in whom this strategy fails, however, and who have a high-mortality rate. Read More

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Treatment for bleeding oesophageal varices in people with decompensated liver cirrhosis: a network meta-analysis.

Cochrane Database Syst Rev 2021 Apr 10;4:CD013155. Epub 2021 Apr 10.

Division of Surgery and Interventional Science, University College London, London, UK.

Background: Approximately 40% to 95% of people with liver cirrhosis have oesophageal varices. About 15% to 20% of oesophageal varices bleed within about one to three years after diagnosis. Several different treatments are available, including, among others, endoscopic sclerotherapy, variceal band ligation, somatostatin analogues, vasopressin analogues, and balloon tamponade. Read More

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Relationship between hemodynamic parameters and portal venous pressure in cirrhosis patients with portal hypertension.

Open Life Sci 2020 31;15(1):981-987. Epub 2020 Dec 31.

Gerontological Surgery Department, Xi'an International Medical Center, Xi'an, 710100, China.

Cirrhosis caused by viral and alcoholic hepatitis is an essential cause of portal hypertension (PHT). The incidence of PHT complication is directly proportional to portal venous pressure (PVP), and the clinical research of PVP and its hemodynamic indexes is of great significance for deciding the treatment strategy of PHT. Various techniques are currently being developed to decrease portal pressure but hemodynamic side effects may occur. Read More

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December 2020

Secondary prevention of variceal bleeding in adults with previous oesophageal variceal bleeding due to decompensated liver cirrhosis: a network meta-analysis.

Cochrane Database Syst Rev 2021 03 30;3:CD013122. Epub 2021 Mar 30.

Division of Surgery and Interventional Science, University College London, London, UK.

Background: Approximately 40% to 95% of people with cirrhosis have oesophageal varices. About 15% to 20% of oesophageal varices bleed in about one to three years of diagnosis. Several different treatments are available, which include endoscopic sclerotherapy, variceal band ligation, beta-blockers, transjugular intrahepatic portosystemic shunt (TIPS), and surgical portocaval shunts, among others. Read More

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Transjugular intrahepatic portosystemic shunt creation may be associated with hyperplastic hepatic nodular lesions in the long term: an analysis of 18 pediatric and young adult patients.

Pediatr Radiol 2021 Mar 30. Epub 2021 Mar 30.

Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, USA.

Background: Retrospective studies have demonstrated the efficacy and safety of pediatric and adolescent transjugular intrahepatic portosystemic shunt (TIPS), but long-term outcomes warrant further investigation.

Objective: To report on the development of hyperplastic hepatic nodular lesion development in children and young adults (<21 years) with TIPS patency >3 years.

Materials And Methods: Eighteen children and young adults, including 10 (55. Read More

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Impact of transjugular intrahepatic portosystemic shunt creation on the central lymphatic system in liver cirrhosis.

Sci Rep 2021 Mar 29;11(1):7065. Epub 2021 Mar 29.

Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53105, Bonn, Germany.

The puropse of this study was to evaluate associations of cisterna chyli (CCh) diameter with portal hemodynamics and the influence of TIPS-creation in cirrhotic patients. 93 cirrhotic patients (57 male, mean age 59 years) received CT prior to TIPS-creation. 38/93 additionally underwent post-interventional CT. Read More

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Updated strategies in the management of acute variceal haemorrhage.

Curr Opin Gastroenterol 2021 May;37(3):167-172

Digestive Disease Research Center, Medical University of South Carolina, Charleston, South Carolina, USA.

Purpose Of Review: This article reviews the most recent studies regarding the management of acute esophageal variceal haemorrhage.

Recent Findings: New randomized control trials and meta-analyses confirmed the role of early transjugular intrahepatic portosystemic shunt (TIPS) in the management of acute variceal haemorrhage in Child-Pugh C (10-13) and B patients with active bleeding. A recent randomized controlled trial focused on the duration of vasoactive therapy showed no difference between 2 and 5 days of octreotide. Read More

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Diagnosis and clinical management of hepatosplenic schistosomiasis: A scoping review of the literature.

PLoS Negl Trop Dis 2021 Mar 25;15(3):e0009191. Epub 2021 Mar 25.

Department of Infectious-Tropical Diseases and Microbiology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.

Background: Hepatosplenic schistosomiasis (HSS) is a disease caused by chronic infection with Schistosma spp. parasites residing in the mesenteric plexus; portal hypertension causing gastrointestinal bleeding is the most dangerous complication of this condition. HSS requires complex clinical management, but no specific guidelines exist. Read More

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Management of Portal Vein Thrombosis in Cirrhosis.

Semin Liver Dis 2021 Jan 9;41(1):79-86. Epub 2021 Feb 9.

Division of Gastroenterology and Hepatology, UVA Center for the Study of Hemostasis and Thrombosis in Liver Disease, University of Virginia, Charlottesville, Virginia.

While portal vein thrombosis (PVT) is a frequently encountered complication in the cirrhosis population, its management can be challenging for even the most experienced clinicians. Multiple factors must be considered with regards to management, including the degree of underlying portal hypertension and liver dysfunction, risks of therapies including anticoagulation and transjugular intrahepatic portosystemic shunt placement, and extent of the thrombosis. Interpreting the available literature to determine the best treatment strategy for any individual patient can be especially challenging given the lack of prospective, randomized controlled trials and the heterogeneity of cohorts studied. Read More

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January 2021

The role of pre-emptive Transjugular Intrahepatic Portosystemic Shunt in acute variceal bleeding: a literature review.

Ther Adv Chronic Dis 2021 5;12:2040622321995771. Epub 2021 Mar 5.

Norfolk and Norwich University Hospital, Norwich, NR4 7UB, UK.

The development of portal hypertension has serious implications in the natural history of liver cirrhosis, leading to complications such as ascites, hepatic encephalopathy and variceal bleeding. The management of acute variceal bleeding has improved in the last two decades, but despite the advances in endoscopic methods the overall prognosis remains poor, particularly within a subgroup of patients with more advanced disease. The role of Transjugular Intrahepatic Portosystemic Shunt (TIPSS) is a well-established method of achieving haemostasis by immediate portal decompression; however, its use in an emergency setting as a rescue strategy is still associated with high mortality. Read More

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Editorial: stratifying risk of adverse outcomes in cirrhosis: the Hepquant SHUNT test.

Aliment Pharmacol Ther 2021 04;53(8):939-940

Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.

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Efficacy of puncturing different portal vein branch during transjugular intrahepatic portosystemic shunt with 8 mm covered stent: a propensity-score analysis.

Eur J Gastroenterol Hepatol 2021 Mar 19. Epub 2021 Mar 19.

Department of Interventional Radiology, Zhongshan Hospital, Fudan University Shanghai Institution of Medical Imaging, Fudan University National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China.

Background: Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) remains an unsolved problem; therefore, this study aimed to compare the efficacy of shunting different portal vein branch during TIPS with 8 mm covered stent for preventing gastroesophageal variceal rebleeding in cirrhotic patients.

Methods: Between November 2015 and December 2018, the medical records of consecutive cirrhotic patients who received TIPS with an 8 mm covered stent for preventing gastroesophageal variceal rebleeding were analyzed retrospectively. Shunting the left and right branches of the portal vein was performed in 58 (group A) and 104 patients (group B), respectively. Read More

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Venous mesenteric ischemia carries high procedural burden and elevated mortality in patients with severe presentation.

J Vasc Surg Venous Lymphat Disord 2021 Mar 17. Epub 2021 Mar 17.

Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.

Objective: Venous mesenteric ischemia (VMI) presents with variable severity resulting in a spectrum of outcomes. This study sought to characterize the natural history of VMI and identify drivers of intervention and adverse outcomes.

Methods: All patients who presented to our institution with acute and subacute VMI between 1993 and 2016 were identified. Read More

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Recanalization and Reconstruction of a Chronically Occluded Inferior Vena Cava Through an Existing Transjugular Intrahepatic Portosystemic Shunt in the Setting of Budd-Chiari Syndrome.

Vasc Endovascular Surg 2021 Mar 19:15385744211002026. Epub 2021 Mar 19.

Division of Vascular and Interventional Radiology, Department of Radiology, University of Minneapolis, MN, USA.

Budd-Chiari syndrome (BCS) results from the occlusion or flow reduction in the hepatic veins or inferior vena cava and can be treated with transjugular intrahepatic portosystemic shunt when hepatic vein recanalization fails. Hypercoagulable patients with primary BCS are predisposed to development of new areas of thrombosis within the TIPS shunt or IVC. This case details a patient with BCS, pre-existing TIPS extending to the right atrium, and chronic retrohepatic IVC thrombosis who underwent sharp recanalization of the IVC with stenting into the TIPS stent bridging the patient until his subsequent hepatic transplantation. Read More

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