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Intractable Rare Dis Res 2019 Feb;8(1):60-66

Venous Thromboembolism Unit, Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Behçet's Disease (BD) is a rare, chronic and recurrent inflammatory multisystemic condition of unknown origin that can affect any tissue. The vascular system is involved in 5-40% of cases of BD, including venous and arterial beds and it has a relapsing course. Budd-Chiari syndrome (BCS) is a rare complication of BD with a frequency of < 5% among patients with vascular involvement and is more frequent in men (89. Read More

World J Gastroenterol 2019 Mar;25(9):1088-1099

Department of Ultrasound, Air Force Medical Center of PLA, Beijing 100142, China.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is currently used for the treatment of complications of portal hypertension. The incidence of hepatic encephalopathy (HE) remains a problem in TIPS placement. It has been reported that the right branch mainly receives superior mesenteric venous blood while the left branch mainly receives blood from the splenic vein. Read More

BMC Cardiovasc Disord 2019 Mar 5;19(1):54. Epub 2019 Mar 5.

Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China.

Background: The retrievable stent filter (RSF) has been previously used for the treatment of vena cava thrombosis. In this study, the RSF was implanted to treat aortic thrombosis and then withdrawn.

Case Presentation: A 47-years-old woman presented with severe abdominal pain and fever. Read More

Aliment Pharmacol Ther 2019 Apr 3;49(7):840-863. Epub 2019 Mar 3.

Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.

Background: Budd-Chiari syndrome (BCS) is a rare but fatal disease caused by obstruction in the hepatic venous outflow tract.

Aim: To provide an update of the pathophysiology, aetiology, diagnosis, management and follow-up of BCS.

Methods: Analysis of recent literature by using Medline, PubMed and EMBASE databases. Read More

Dig Liver Dis 2019 Feb 7. Epub 2019 Feb 7.

Department of Experimental and Clinical Medicine, University of Florence, Italy; Research Center Denothe, University of Florence, Italy. Electronic address:

Background: Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a well-established treatment for complications of portal hypertension.

Aims: To analyze the impact of TIPS on virologic response and safety profile in patients treated with direct-acting antivirals (DAAs).

Methods: We analyzed data from HCV-positive cirrhotic patients treated with DAAs. Read More

Aliment Pharmacol Ther 2019 Apr 28;49(7):926-939. Epub 2019 Feb 28.

Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.

Background: In patients with idiopathic non-cirrhotic portal hypertension (INCPH), the usual recommended strategy for management of variceal bleeding is the same as that in cirrhosis. However, this policy has been challenged by the different natural history between INCPH and cirrhosis.

Aim: To compare outcomes after transjugular intrahepatic portosystemic shunt (TIPSS) between INCPH and cirrhotic patients admitted for variceal bleeding. Read More

World J Hepatol 2019 Feb;11(2):217-225

Department of Radiology, University of Kentucky, Lexington, KY 40536, United States.

Background: Transjugular intrahepatic portosystemic shunts (TIPS) can alleviate complications of portal hypertension such as ascites and variceal bleeding by decreasing the portosystemic gradient. In limited clinical situations, parallel TIPS may be only solution to alleviate either variceal bleeding or ascites secondary to portal hypertension when the primary TIPS fails to do so. Data specifically addressing the use of this partially polytetrafluoroethylene covered nitinol stent (Viatorr) is largely lacking despite Viatorr being the current gold standard for modern TIPS placement. Read More

PLoS One 2019 27;14(2):e0212658. Epub 2019 Feb 27.

Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) creation is an established treatment option to management the complications of portal hypertension. Recent data on the long-term outcomes of TIPS are scarce.

Materials And Methods: In this single-institution retrospective study, 495 patients underwent TIPS with the Fluency stent-grafts between December 2011 and June 2015 were evaluated. Read More

J Clin Gastroenterol 2019 Feb 22. Epub 2019 Feb 22.

Department of Radiology, Division of Interventional Radiology.

Portal hypertension, a consequence of end-stage liver disease and liver cirrhosis can lead to significant morbidity and mortality for patients through abnormal fluid accumulation as well as the formation of portosystemic shunts and varices. Treatment of the sequelae of portal hypertension can be achieved through endovascular management by referral to an interventional radiologist on an outpatient or emergent basis as required. Current techniques include the placement of peritoneovenous shunts and tunneled peritoneal drains, the creation of transjugular intrahepatic portosystemic shunts, or the obliteration of shunts via balloon-occluded retrograde transvenous obliteration (BRTO). Read More

Cardiovasc Intervent Radiol 2019 Feb 20. Epub 2019 Feb 20.

Department of Gastroenterology, University Hospital of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.

Adjuvant embolization of varices may reduce rebleeding in patients with a transjugular intrahepatic portosystemic shunt (TIPS). The aim of this study was to investigate the efficacy and the risks of adjuvant variceal embolization at TIPS implantation using bucrylate.

Patients And Methods: The retrospective study evaluated 104 of 237 cirrhotic patients with TIPS for variceal bleeding who received adjuvant bucrylate embolization. Read More

Aliment Pharmacol Ther 2019 Mar 17;49(6):797-806. Epub 2019 Feb 17.

Liver Unit, Queen Elizabeth University Hospital, Birmingham, UK.

Background: Cardiac dysfunction is frequently observed in patients with cirrhosis. There remains a paucity of data from routine clinical practice regarding the role of echocardiography in the pre-assessment of transjugular intrahepatic portosystemic stent-shunt.

Aim: Our study aimed to investigate if echocardiography parameters predict outcomes after transjugular intrahepatic portosystemic stent-shunt insertion in cirrhosis. Read More

J Clin Exp Hepatol 2019 Jan-Feb;9(1):56-61. Epub 2018 Mar 1.

Consultant, Department of Vascular and Interventional Radiology, Tan Tock Seng Hospital, Singapore.

Background: There has been significant improvement in understanding the etiology and management of Budd-Chiari Syndrome (BCS). Patients with chronic or acute-on-chronic BCS need radiological interventions in the form of angioplasty, hepatic vein/inferior vena cava stenting or Transjugular Intrahepatic Portosystemic Shunt (TIPS). Data regarding the long term follow up of patients undergoing TIPS is limited. Read More

Liver Int 2019 Feb 9. Epub 2019 Feb 9.

Department of Medicine I, University of Bonn, Bonn, Germany.

Background & Aims: Remodelling of extracellular matrix is crucial in progressive liver fibrosis. Collagen type III desposition has been shown in acute decompensation. Extratracellular matrix is compiled of deposition of various components. Read More

Gastroenterol Res Pract 2019 9;2019:2935498. Epub 2019 Jan 9.

Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong, China.

Purpose: To evaluate the effect of puncture sites of the portal vein in transjugular intrahepatic portosystemic shunt (TIPS) on long-term clinical efficacy.

Methods: A retrospective review was performed, including consecutive 171 patients who underwent TIPS with ePTFE-covered stents. All patients were divided into 3 groups according to the puncture site of the portal vein: intrahepatic bifurcation of the portal vein (group A, = 88), right branch of the portal vein (group B, = 48), and left branch of the portal vein (group C, = 35). Read More

Semin Intervent Radiol 2018 Dec 5;35(5):492-496. Epub 2019 Feb 5.

Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.

J Vasc Interv Radiol 2019 Feb;30(2):187-194

Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22903. Electronic address:

Purpose: To assess short- and long-term mortality and rebleeding with endoscopic cyanoacrylate (EC) versus balloon-occluded retrograde transvenous obliteration (BRTO).

Materials And Methods: A retrospective cohort comparison was conducted of 90 EC patients and 71 BRTO patients from 1997 through 2015 with portal hypertension who presented due to endoscopically confirmed bleeding cardiofundal gastric varices. Patients underwent either endoscopic intra-varix injection of 4-carbon-n-butyl-2-cyanoacrylate or sclerosis with sodium tetradecyl sulfate with balloon occlusion for primary variceal treatment. Read More

J Vasc Interv Radiol 2019 Feb;30(2):178-186.e5

Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington.

Purpose: To examine the technical feasibility and clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation in children and adolescents.

Materials And Methods: Retrospective review was performed of 59 patients (mean age 12.6 y [range, 1. Read More

J Vasc Interv Radiol 2019 Feb;30(2):170-177

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; Institute of Interventional Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address:

Purpose: To evaluate effect of transjugular intrahepatic portosystemic shunt (TIPS) creation on pulmonary gas exchange in patients with hepatopulmonary syndrome (HPS).

Materials And Methods: All patients with cirrhosis or Budd-Chiari syndrome undergoing elective TIPS creation at a single institution between June 2014 and June 2015 were eligible for inclusion. Twenty-three patients with HPS (age 55. Read More

J Vasc Interv Radiol 2019 Feb;30(2):154-161

Department of Medicine, University of Alabama at Birmingham, Birmingham, D619 19th Street South, AL 35249; Department of Radiology, University of Alabama at Birmingham, Birmingham, D619 19th Street South, AL 35249. Electronic address:

Purpose: To examine the role of psoas muscle density (PD) measurement before transjugular intrahepatic portosystemic shunt (TIPS) creation in predicting survival when combined with Model for End-stage Liver Disease (MELD) score.

Materials And Methods: The medical records of 241 patients with cirrhosis who underwent TIPS creation between June 2005 and June 2015 were retrospectively reviewed. The patients were divided into 2 groups: those with variceal bleeding (VB; n = 113) and those with volume overload (VO; n = 128). Read More

Diagn Interv Imaging 2019 Jan 30. Epub 2019 Jan 30.

Department of Radiology, centre hospitalier universitaire de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France.

Purpose: The purpose of our study was to retrospectively assess the safety and efficacy of percutaneous real-time ultrasound guidance for portal vein puncture during transjugular intrahepatic portosystemic shunt (TIPS) placement.

Materials And Methods: Between January 2011 and November 2018, procedure details and outcome were retrospectively analyzed for 224 patients who underwent TIPS placement using real-time ultrasound guidance for portal vein puncture. There were 175 men and 49 women with a mean age of 52. Read More

Neural Regen Res 2019 May;14(5):850-857

Department of Radiology, Xijing Hospital, Air Force Military Medical University (Fourth Military Medical University), Xi'an, Shaanxi Province, China.

Hepatic myelopathy is a complication seen in patients with chronic liver failure with physiologic or iatrogenic portosystemic shunting. The main symptom is progressive lower limb dyskinesia. The role of the brain motor control center in hepatic myelopathy is unknown. Read More

Cardiovasc Intervent Radiol 2019 Jan 14. Epub 2019 Jan 14.

Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China.

Purpose: Conflicting data exist regarding the appropriate shunt diameter for transjugular intrahepatic portosystemic shunt (TIPS) creation in cirrhotic patients. This study was designed to compare the clinical efficacy of TIPS using stent-grafts with 8- and 10-mm diameters.

Methods: In this retrospective study, cirrhotic patients who underwent TIPS technical successfully for the prevention of variceal rebleeding from December 2011 to June 2015 were included. Read More

Zhonghua Yi Xue Za Zhi 2019 Jan;99(1):44-48

Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.

To assess the effect of monochromatic images and metal artifact reduction (MAR) on the image quality of spectral CT portal venous angiography in patients with operation of after the performing transjugular intrahepatic portosystemic stent shunt(TIPS) and embolization. From December 2017 to April 2018, the examination data of 28 patients with portal hypertension due to cirrhosis who underwent portal vein angiography 1 month after TIPS and embolization were prospectively collected. After spectral CT scanning in revolution CT, the monochromatic energy levels(60 keV, 120 keV), 60 keV + 120 keV, 120kV-like + 120 keV fused images combined with MAR algorithm were reconstructed. Read More

J Vasc Interv Radiol 2019 Feb 11;30(2):163-169. Epub 2019 Jan 11.

Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, 2301 Erwin Road, Durham, North Carolina 27710. Electronic address:

Purpose: To determine whether proton pump inhibitor (PPI) use increases the rate of new or worsening hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation.

Materials And Methods: In this retrospective study, 284 of 365 patients who underwent TIPS creation from January 1, 2005, to December 31, 2016, were analyzed (186 male, mean age 56 y, range 19-84 y). Dates of PPI use and dates of new or worsening HE, defined as hospitalization or escalation in outpatient medical management, were extracted from medical records. Read More

J Vasc Interv Radiol 2019 Feb 9;30(2):148-153.e2. Epub 2019 Jan 9.

Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 15 West Changle Road, Xi'an 710032, China. Electronic address:

Purpose: To investigate the role of early overt hepatic encephalopathy (OHE) as a clinical marker of prognosis in cirrhosis with a transjugular intrahepatic portosystemic shunt (TIPS) and to assess the relationship between recurrence of OHE and survival after TIPS.

Methods: From January 2012 to December 2013, a retrospective study of consecutive patients with cirrhosis and a TIPS was performed at a single institution. A total of 304 patients (196 males; mean age, 52 years) were enrolled during the study period. Read More

Cardiovasc Intervent Radiol 2019 Jan 2. Epub 2019 Jan 2.

Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Box 3808, 2301 Erwin Road, Durham, NC, 27710, USA.

Purpose: To compare survival after transjugular intrahepatic portosystemic shunt (TIPS) creation versus serial large volume paracenteses (LVP) in patients with refractory ascites and higher Model for End-Stage Liver Disease (MELD) scores.

Materials And Methods: In this retrospective study, from 1/1/2013 to 10/1/2018, 478 patients (294 male; mean age 58, range 23-89) underwent serial LVP (n = 386) or TIPS (n = 92) for ascites. Propensity-matched cohorts were constructed based on age, MELD, Charlson comorbidity index, varices, and hepatic encephalopathy. Read More

PLoS One 2018 28;13(12):e0208233. Epub 2018 Dec 28.

Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, United States of America.

Background And Aims: Transjugular intrahepatic portosystemic shunt (TIPS) may be placed to treat complications of portal hypertension by creating a conduit between the hepatic and portal vein. The diagnosis of hepatocellular carcinoma (HCC) is typically made by multiphasic imaging studies demonstrating arterial enhancement with washout on arterial, portal venous, and delayed phase imaging. The aim of our study was to determine how the presence of TIPS would affect the imaging diagnosis of HCC. Read More

Eur J Gastroenterol Hepatol 2018 Dec 13. Epub 2018 Dec 13.

Hepatology and Liver Transplant Unit, Department of Medical Area (DAME).

Objectives: Transjugular intrahepatic portosystemic shunt (TIPS) is adopted to treat refractory complications of portal hypertension, such as variceal bleeding and ascites. This study aimed to assess predictors of hepatic encephalopathy (HE) development and cumulative transplant-free survival after TIPS placement in patients with cirrhosis complicated by refractory ascites and major gastroesophageal bleeding.

Materials And Methods: Sixty-three cirrhotic patients who underwent TIPS positioning as a secondary prophylaxis of major upper gastroesophageal bleeding (N=30) or to control refractory ascites (N=33) were enrolled. Read More

Tech Vasc Interv Radiol 2018 Dec 29;21(4):267-287. Epub 2018 Jul 29.

Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA. Electronic address:

Portal venous interventions comprise a large portion of many Interventional Radiology practices today, and remain some of the more technically challenging cases in one's repertoire of procedures. The patients upon whom these procedures are performed are often critically ill, have decompensated disease, or are burdened with comorbid conditions such that they are poor surgical candidates. This leaves them with few options outside the care of Interventional Radiology. Read More

Diagn Interv Imaging 2018 Dec 3. Epub 2018 Dec 3.

Department of Radiology, University of Minnesota, 420 Delaware St SE, MMC 292, 55455 Minneapolis, USA.

Purpose: To compare the outcomes in patients who had transjugular intrahepatic portosystemic shunts (TIPS) placed for hepatic hydrothorax with those who had it placed for refractory ascites.

Materials And Methods: One hundred and forty-seven patients who underwent TIPS placement for refractory fluid accumulation were included. There were 97 men and 50 women with a mean age of 56. Read More

Eur Radiol 2018 Nov 30. Epub 2018 Nov 30.

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, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.

Objectives: To evaluate the changes in arterial oxygenation after portal decompression in Budd-Chiari syndrome (BCS) patients with hepatopulmonary syndrome (HPS).

Methods: From June 2014 to June 2015, all patients with BCS who underwent balloon angioplasty or transjugular intrahepatic portosystemic shunt (TIPS) creation at our institution were eligible for inclusion in this study. Arterial blood gas analysis was performed with the patient in an upright position and breathing room air at 2-3 days and 1 and 3 months after the procedure. Read More

Transplant Rev (Orlando) 2019 04 31;33(2):64-71. Epub 2018 Oct 31.

Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States; Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; Yale Cancer Center, Yale School of Medicine, New Haven, CT, United States. Electronic address:

Liver transplantation is one of the mainstays of treatment for liver failure due to severe chronic liver disease. Bridging therapies, such as placement of a transjugular intrahepatic portosystemic shunt (TIPS), are frequently employed to control complications of portal hypertension such as ascites, hydrothorax, and variceal bleeding, and thereby reduce morbidity in patients awaiting transplant. There is no significant difference seen in either graft survival or patient survival between those receiving TIPS pre-transplant and those who do not, although those receiving TIPS placement on average have a longer waiting time on the transplant waitlist. Read More

Clin Imaging 2019 Jan - Feb;53:221-224. Epub 2018 Oct 23.

Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA.

A 72-year-old male presented with refractory ascites secondary to portal vein occlusion with cavernomatous transformation following pancreaticoduodenectomy (Whipple procedure). Due to the unfavorable anatomy, transjugular intrahepatic portosystemic shunt was not an option. However, given patency of the spleno-mesenteric confluence and absence of the pancreatic head after the Whipple procedure, a splenomeso-caval shunt was successfully created using a transjugular-transsplenic rendezvous technique. Read More

J Transl Int Med 2018 Sep 9;6(3):97-104. Epub 2018 Oct 9.

Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.

Budd-Chiari syndrome (BCS) is a rare but fatal disease caused by the obstruction in hepatic venous outflow tract (usually by thrombosis) and is further classified into two subtypes depending on the level of obstruction. Patients with BCS often have a combination of prothrombotic risk factors. Clinical presentation is diverse. Read More

Clin Imaging 2019 Jan - Feb;53:200-203. Epub 2018 Oct 27.

Department of Radiology, University of Kentucky Chandler Medical Center, Lexington, KY, United States of America. Electronic address:

Transjugular intrahepatic portosystemic shunt (TIPS) periprocedural thrombosis rates have fallen significantly since the introduction of polytetrafluoroethylene-covered stent grafts. We present a case of a cirrhotic patient with portal hypertension presenting with early TIPS thrombosis in association with an underlying competing spontaneous left mesenterico-gonadal venous shunt, an uncommon variant of spontaneous portal systemic shunt (SPSS). The patient presented with bleeding distal duodenal varices refractory to endovascular therapy, and although a successful TIPS procedure was performed for this indication, early thrombosis was determined by follow-up abdominopelvic computed tomographic angiography (CTA) scan. Read More

Gut 2018 Nov 10. Epub 2018 Nov 10.

Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.

Objectives: Early placement of transjugular intrahepatic portosystemic shunt (TIPS) has been shown to improve survival in high-risk patients (Child-Pugh B plus active bleeding at endoscopy or Child-Pugh C 10-13) with cirrhosis and acute variceal bleeding (AVB). However, early TIPS criteria may overestimate the mortality risk in a significant proportion of patients, and the survival benefit conferred by early TIPS in such patients has been questioned. Alternative criteria have been proposed to refine the criteria used to identify candidates for early TIPS. Read More

Medicine (Baltimore) 2018 Oct;97(43):e12944

Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University.

This study aimed to evaluate the long-term efficacy and safety of percutaneous transhepatic balloon angioplasty (PTBA) and transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the treatment of Budd-Chiari syndrome (BCS) with hepatic veins involvement. Between June 2008 and August 2016, a total of 60 BCS patients with hepatic vein involvement in our department were enrolled in this study. Thirty-three cases underwent hepatic vein balloon angioplasty in PTBA Group and 27 cases underwent TIPSS. Read More

J Vasc Interv Radiol 2018 12 3;29(12):1717-1724. Epub 2018 Nov 3.

Department of Radiology, Washington University School of Medicine, St. Louis, Missouri.

Purpose: To demonstrate the feasibility of detecting patency, stenosis, or occlusion of transjugular intrahepatic portosystemic shunt (TIPS) with four-dimensional (4D) flow MR imaging.

Materials And Methods: Sequential adult patients with TIPS were eligible for enrollment. Volumetric phase-contrast sequence was used to image TIPS. Read More

J Vasc Interv Radiol 2018 12 2;29(12):1705-1712. Epub 2018 Nov 2.

Department of Interventional Radiology, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA 98195.

Purpose: To compare relative cost-effectiveness of serial large-volume paracentesis (LVP) and transjugular intrahepatic portosystemic shunt (TIPS) creation for treatment of refractory ascites.

Materials And Methods: A decisional Markov model was developed to estimate payer cost and quality-adjusted life-ears (QALYs) associated with LVP and TIPS treatment strategies for cirrhotic patients with refractory ascites. Survival estimates were derived from an individual patient-level meta-analysis of prospective randomized clinical trials. Read More

J Vasc Interv Radiol 2018 12 2;29(12):1713-1716. Epub 2018 Nov 2.

Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. Electronic address:

Three patients with a medical history of breast carcinoma and metastatic carcinomatous liver disease associated with severe portal hypertension and refractory ascites are presented. Transjugular intrahepatic portosystemic shunt creation was considered as a palliative treatment option and a valuable alternative to regular paracenteses in these patients. In 2 of the 3 patients, the refractory ascites was controlled for several months without need for paracentesis, and subsequently transjugular intrahepatic portosystemic shunt may provide valuable palliation and ascites control in patients with refractory ascites due to breast cancer-induced pseudocirrhosis. Read More

Cureus 2018 Aug 22;10(8):e3180. Epub 2018 Aug 22.

Interventional Radiology, University of Florida Health, Jacksonville, USA.

A transjugular intrahepatic portosystemic shunt is the standard of care for complications of portal hypertension, such as variceal bleeding, refractory ascites, and hepatic hydrothorax. Hepatic encephalopathy, hepatic insufficiency, and right heart failure are the major complications after shunt creation. If medical management is unsuccessful, the interventionalist is consulted to close/revise the shunt. Read More

J Clin Exp Hepatol 2018 Sep 30;8(3):256-261. Epub 2017 Dec 30.

Transplant and Advanced Liver Disease Center, Banner University Medical Center, Phoenix, AZ, USA.

Background/aims: Hepatic encephalopathy (HE) is a well-recognized complication of transjugular intrahepatic portosystemic shunt (TIPS) placement. The aim of this investigation was to evaluate incidence and predictors of post-TIPS HE necessitating hospital admission in a non-clinical trial setting.

Methods: We performed a retrospective cohort study identifying 273 consecutive patients undergoing TIPS from 2010 to 2015 for any indication; 210 met inclusion/exclusion criteria. Read More

Pediatr Radiol 2019 01 6;49(1):128-135. Epub 2018 Oct 6.

Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) placement has been extensively studied in adults. The experience with TIPS placement in pediatric patients, however, is limited.

Objective: The purpose of this study was to report technical success and clinical outcomes in pediatric patients undergoing TIPS placement. Read More

Abdom Radiol (NY) 2019 Mar;44(3):1127-1134

Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to treat portal hypertension complications. Our aim was to evaluate liver and spleen stiffness measurement (LSM and SSM, respectively) changes using acoustic radiation force impulse imaging (ARFI) in comparison to Child-Pugh scores for predicting hepatic venous pressure gradient (HVPG) decreases after TIPS implantation.

Methods: This prospective study included 31 consecutive clinically significant portal hypertension patients with TIPS indication. Read More

Virol J 2018 10 1;15(1):151. Epub 2018 Oct 1.

Department of Radiology, China-Japan Union Hospital of Jilin University, 126 Xintai St, Changchun, 130022, Jilin Province, China.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) procedure has played a vital role in management of portal hypertension. Thus, we aimed to investigate the natural history, long-term clinical outcome, predictors of survival in viral hepatitis related cirrhotic patients post-TIPS.

Method: A total of 704 patients with complete followed-up data were enrolled, and clinical characteristics of patients were collected and analyzed. Read More

Diagn Interv Imaging 2018 Dec 29;99(12):793-799. Epub 2018 Sep 29.

Department of Radiology, University of Minnesota, Minneapolis, MN 55455, USA.

Purpose: The purpose of this study was to review and compare outcomes between percutaneous sclerotherapy and transjugular intrahepatic portosystemic shunt (TIPS) treatments in patients with peristomal variceal bleeding.

Materials And Methods: Ten patients who underwent sclerotherapy (n = 3 patients), TIPS placement (n = 5 patients) or both (n= 2 patients) for peristomal variceal bleeding were retrospectively reviewed. There were 6 women and 4 men, with a mean age of 62. Read More

Hepatobiliary Pancreat Dis Int 2018 Dec 7;17(6):517-523. Epub 2018 Sep 7.

Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China. Electronic address:

Background: Treatment options for patients with cavernous transformation of portal vein (CTPV) are limited. This study aimed to evaluate the feasibility, efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) to prevent recurrent esophageal variceal bleeding in patients with CTPV.

Methods: We retrospectively analyzed 67 consecutive patients undergone TIPS from January 2011 to December 2016. Read More

Case Rep Radiol 2018 23;2018:9261268. Epub 2018 Aug 23.

Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA.

Transjugular intrahepatic portosystemic shunt (TIPS) is an alternative interventional procedure used to manage refractory Budd-Chiari syndrome (BCS) when conservative medical therapy has failed. However, TIPS is not always technically successful because of hepatic vein thrombosis and inability to catheterize the hepatic veins. In these situations, direct intrahepatic portosystemic shunt (DIPS) with access to the portal vein from the IVC has been shown to be a viable alternative that may ameliorate portal hypertension in these patients. Read More

Aliment Pharmacol Ther 2018 Oct 4;48(8):863-874. Epub 2018 Sep 4.

Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.

Background: Hepatic encephalopathy (HE) may occur after transjugular intrahepatic portosystemic shunt (TIPSS) placement. Multimodal magnetic resonance imaging (MRI), combining anatomical sequences, diffusion tensor imaging (DTI) and H magnetic resonance spectroscopy, is modified in cirrhotic patients.

Aims: To describe multimodal MRI images before TIPSS, to assess if TIPSS induces changes in multimodal MRI, and to find predictors of HE after TIPSS in patients with cirrhosis. Read More

Eur J Radiol 2018 Sep 30;106:20-25. Epub 2018 Jun 30.

Department of Radiology, Amiens University Hospital, Avenue René Laennec, F-80054 Amiens Cedex 01, France.

Purpose: To evaluate the feasibility, safety and usefulness of 3D CBCT with a new injection protocol for targeting the portal vein during TIPS and to determine if it allows decreasing the duration of the procedure.

Materials And Methods: 3D CBCT was obtained during creation of TIPS in 15 patients (group 2). Portogram quality score was defined using a 5 points scale. Read More