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Medicine (Baltimore) 2022 Jul 1;101(26):e29742. Epub 2022 Jul 1.

Interventional Radiology Department, The First Affiliated Hospital of Three Gorges University, Yichang, China.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is widely applied to decrease portal hypertension. Because of the lack of strong evidence, it is controversial whether anticoagulation should be performed after TIPS. This meta-analysis aimed to assess the safety and efficacy of anticoagulation for patients with portal hypertension following TIPS. Read More

J Natl Med Assoc 2022 Jun 25. Epub 2022 Jun 25.

Carilion Clinic: 1906 Belleview Ave SE, Roanoke, VA 24014.

We present a case report of a patient who is a non-cirrhotic with portal cavernous transformation secondary to previous trauma. The patient presents with portal biliopathy requiring ERCP/EUS with biliary stenting. The patient was referred to Interventional Radiology (IR) for portal vein recanalization. Read More

Diagn Interv Radiol 2022 May;28(3):239-243

Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.

PURPOSE We aimed to evaluate the safety and efficacy of 12 mm diameter polytetrafluoroethylene (PTFE)- covered stents for the creation of transjugular intrahepatic portosystemic shunt (TIPS) in cir- rhotic patients with portal hypertension complicated by variceal bleeding and volume-overload. METHODS This retrospective study included 360 patients who had TIPS created between January 2004 and December 2017 using 12 mm diameter PTFE-covered stents. Demographic data, model for end- stage liver disease (MELD) score, etiology of cirrhosis, and Charlson comorbidity index were recorded. Read More

Sci Rep 2022 Jun 22;12(1):10506. Epub 2022 Jun 22.

Department of Radiology, University Hospital Regensburg, 93042, Regensburg, Germany.

The development of acute thrombosis within the TIPS tract may be prevented by prophylactic anticoagulation; however, there is no evidence of the correct anticoagulation regimen after TIPS placement. The purpose of this single-center retrospective study was to evaluate the short-term occlusion rate of transjugular intrahepatic portosystemic shunts (TIPSs) with polytetrafluorethylene (PTFE)-coated stents under consequent periprocedural full heparinization (target partial thromboplastin time [PTT]: 60-80 s). We analyzed TIPS placements that were followed up over a six-month period by Doppler ultrasound in 94 patients and compared the study group of 54 patients who received intravenous periprocedural full heparinization (target PTT: 60-80 s) without any other anticoagulation to patients with prolonged anticoagulation medication. Read More

Clin Hemorheol Microcirc 2022 Jun 14. Epub 2022 Jun 14.

Department of Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany.

Background: Ultrasound follow-up of transjugular intrahepatic portosystemic shunt (TIPS) is challenging due to the bent course of the stent-graft.

Objective: Aim of this retrospective study was to assess to which extent the combination of HR flow with Glazing Flow improves hemodynamic assessment in the ultrasound follow-up of TIPS.

Methods: Comparative studies with CCDS and High Resolution (HR)-Flow with Glazing Flow were evaluated regarding image quality and artifacts on a 5-point scale (0 = cannot be assessed up to 5 = maximum image quality without artifacts). Read More

World J Hepatol 2022 May;14(5):1038-1046

Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a method used to decrease portal hypertension. Biliary stricture is the rarest of the complications associated with this procedure with only 12 cases previously reported in the literature. None of these cases have documented the resolution of biliary stenosis induced by a stent graft. Read More

Can J Gastroenterol Hepatol 2022 8;2022:3231144. Epub 2022 Jun 8.

Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang 110840, China.

Spontaneous portosystemic shunt (SPSS) refers to collateral vessels that communicate between the portal vein system and systemic circulation. SPSS mainly includes esophageal varices, gastric varices, left gastric vein, recanalized paraumbilical vein, abdominal wall varices, and spontaneous splenorenal shunt. SPSS contributes to the development of hepatic encephalopathy caused by portal vein inflow bypassing and carries a higher risk of death in liver cirrhosis. Read More

Dig Liver Dis 2022 Jun 10. Epub 2022 Jun 10.

Infectious Diseases I Unit, IRCCS San Matteo, Pavia, Italy and Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, V.le Golgi, 19, PV, 27100, Padiglione n. 42, Pavia, Italy; Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Italy.

Background: Infections following transjugular intrahepatic portosystemic shunt (TIPS) placement have been poorly described. We aim to investigate the rate and the potential predictors of infections occurring after TIPS placement.

Methods: Single center, retrospective, observational study. Read More

JHEP Rep 2022 Jul 4;4(7):100484. Epub 2022 Apr 4.

Université Paris Cité; AP-HP, Hôpital Beaujon, Service de Radiologie, Clichy; Centre de Recherche sur l'inflammation Inserm, UMR 1149, Paris, France.

Portal hypertension is defined by an increase in the portosystemic venous gradient. In most cases, increased resistance to portal blood flow is the initial cause of elevated portal pressure. More than 90% of cases of portal hypertension are estimated to be due to advanced chronic liver disease or cirrhosis. Read More

Eur J Radiol 2022 May 28;154:110384. Epub 2022 May 28.

Zhuhai Interventional Medical Centre, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), No. 79 Kangning Road, Zhuhai, China. Electronic address:

Purpose: Preoperative prediction of overt hepatic encephalopathy (OHE) should be performed in patients with variceal bleeding treated using the transjugular intrahepatic portosystemic shunt (TIPS) procedure. A reliable prediction tool is therefore required.

Method: Patients with cirrhosis-related variceal bleeding treated using the TIPS procedure were screened at two hospitals. Read More

Radiol Case Rep 2022 Aug 28;17(8):2603-2606. Epub 2022 May 28.

Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, 22 S. Greene Street, Suite: G2K10, Baltimore, MD 21201, USA.

Portal vein recanalization-transjugular intrahepatic portosystemic shunt (PVR-TIPS) is a valuable technique in the treatment cirrhosis and portal vein (PV) thrombosis. Only a few studies have reported cases of utilizing the transmesenteric approach in the procedure's initial portal access. Here, we report the successful utilization of a CT-guided percutaneous puncture of the superior mesenteric vein (SMV) for PVR-TIPS in a patient with splenic vein thrombosis. Read More

World J Hepatol 2022 Apr;14(4):846-853

Department of Medicine, Division of Gastroenterology and Hepatology, University of Virginia Medical Center, Charlottesville, VA 22903, United States.

Background: Infection of a transjugular intrahepatic portosystemic shunt (TIPS) stent is a rare and serious complication that most commonly occurs during TIPS creation and revision. Patients typically present with recurrent bacteremia due to shunt occlusion or vegetation. To date there are approximately 58 cases reported. Read More

J Vasc Interv Radiol 2022 Jun;33(6):702-706

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, People's Republic of China. Electronic address:

A total of 42 cirrhotic patients (mean age, 51.7 years ± 10.8; 38 men) with hepatocellular carcinoma who underwent emergent transjugular intrahepatic portosystemic shunt (TIPS) creation for controlling acute gastric variceal bleeding (GVB) were included in this multicenter retrospective study. Read More

Biomedicines 2022 Apr 28;10(5). Epub 2022 Apr 28.

Department of Gastroenterology and Hepatology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.

(1) Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a standard therapy for portal hypertension. We aimed to explore the association of established baseline scores with TIPS outcomes. (2) Methods: In total, 136 liver cirrhosis patients underwent TIPS insertion, mainly to treat refractory ascites (86%), between January 2016 and December 2019. Read More

Clin Med Insights Case Rep 2022 18;15:11795476221100595. Epub 2022 May 18.

Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Budd Chiari syndrome (BCS) is defined as obstruction of hepatic venous outflow that can be located anywhere from small hepatic venules up to the entrance of inferior vena cava (IVC) into right atrium. Etiologies of BCS include myeloproliferative disorders, congenital, and acquired hypercoagulable states. Anticoagulation is the mainstay of treatment for all cases of BCS with a demonstrable hypercoagulable state. Read More

Eur J Gastroenterol Hepatol 2022 May 23. Epub 2022 May 23.

Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology.

Objective: To explore the predictive value of model for end-stage liver disease (MELD)-Sarcopenia score for survival of cirrhotic patients after transjugular intrahepatic portosystemic shunt (TIPS) placement.

Methods: 289 patients who underwent TIPS between February 2016 and December 2020 were included, they were divided into the sarcopenia group (n = 138) and non-sarcopenia group (n = 151) according to whether they were complicated with sarcopenia. Kaplan-Meier curve was used to analyze and compare the prognosis of the above two groups and multivariate Cox regression analysis was used to identify the independent prognostic factors. Read More

Liver Int 2022 May 20. Epub 2022 May 20.

Department of Liver Diseases and Interventional Radiology, Digestive Diseases Hospital, Xi'an International Medical Center Hospital, Northwest University, China.

Liver diseases are a major cause of illness and death worldwide. In China, liver diseases, primarily viral hepatitis, affect approximately 300 million people, thus having a major impact on the global burden of liver diseases. Portal hypertension is the most severe complication of chronic liver diseases, including ascites, hepatic encephalopathy and bleeding from gastroesophageal varices. Read More

Lancet Gastroenterol Hepatol 2022 May 16. Epub 2022 May 16.

Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China; Department of Liver Diseases and Interventional Radiology, Digestive Diseases Hospital, Xi'an International Medical Center Hospital, Northwest University, Xi'an, China. Electronic address:

Background: The role of variceal embolisation at the time of transjugular intrahepatic portosystemic shunt (TIPS) creation for the prevention of gastro-oesophageal variceal rebleeding remains controversial. This study aimed to evaluate whether adding variceal embolisation to TIPS placement could reduce the incidence of rebleeding after TIPS in patients with cirrhosis.

Methods: We did an open-label, randomised controlled trial at one university hospital in China. Read More

J Interv Med 2022 Feb 26;5(1):37-39. Epub 2022 Feb 26.

Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.

We report two cases of hepatic encephalopathy caused by molecular targeted drugs after the Transjugular intrahepatic portosystemic shunt (TIPS) procedure in our center. The liver toxicities and anti-angiogenic effects induced by targeted drugs may generate an imbalance in ammonia metabolism, elevating blood ammonia levels. TIPS diverts partial blood supply from the liver, aggravates liver impairment, and shunts ammonia-rich blood from the intestine into the systemic circulation. Read More

AJR Am J Roentgenol 2022 May 18. Epub 2022 May 18.

Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, Oregon, USA.

The most challenging and time-consuming step of transjugular intrahepatic portosystemic shunt (TIPS) procedures is obtaining appropriate portal vein access. Given the lack of real-time direct target visualization, conventional fluoroscopic guidance requires multiple passes, contributing to complications. In comparison, intravascular ultrasound (IVUS) guidance during TIPS procedures provides direct visualization of hepatic structures and real-time guidance for portal vein puncture. Read More

J Clin Exp Hepatol 2022 Mar-Apr;12(2):649-653. Epub 2021 Sep 10.

Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.

Although stomal and parastomal varices are uncommon causes of variceal bleeding, the mortality rate might be as high as 40%. Timely intervention is essential for the management of these ectopic bleeding varices. Due to the rarity of such varices, no standard treatment guideline is available. Read More

J Clin Exp Hepatol 2022 Mar-Apr;12(2):595-602. Epub 2021 Sep 4.

Institute of Gastrosciences & Liver, Apollo Gleneagles Hospital, Kolkata, India.

Acute variceal bleeding is the major cause of mortality in patients with cirrhosis. The standard medical and endoscopic treatment has reduced the mortality of variceal bleeding from 50% to 10-20%. The refractory variceal bleed is either because of failure to control the bleed or failure of secondary prophylaxis. Read More

Zhonghua Nei Ke Za Zhi 2022 May;61(5):548-551

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

To explore the medium-long term efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for gastrointestinal hemorrhage in patients with idiopathic non-cirrhotic portal hypertension (INCPH). From March 2013 to July 2018, clinical data of 13 INCPH patients, including 5 males, 8 females,with gastrointestinal hemorrhage were retrospectively analyzed, who were diagnosed at the First Affiliated Hospital of Zhengzhou University, Anyang Fifth People' s Hospital and Yuncheng Central Hospital. All patients received TIPS treatment. Read More

Zhonghua Nei Ke Za Zhi 2022 May;61(5):537-542

Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.

To evaluate whether underdilated stent could reduce the occurrence of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation. A total of 197 patients with decompensated liver cirrhosis, who had underwent TIPS creation at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively, including 110 males and 87 females with age 25-79 (54±11) years old. Uncovered and covered stents with 8 mm diameter were implanted in all subjects, and then dilated by balloon catheters with 6 mm or 8 mm diameter. Read More

Cureus 2022 Mar 22;14(3):e23399. Epub 2022 Mar 22.

Transplant Hepatology, Albert Einstein College of Medicine, Bronx, USA.

Biloma is an intrahepatic or extrahepatic collection of bile within the abdominal cavity. It can occur spontaneously, or as a result of trauma to the biliary tree. The clinical presentation can be variable and non-specific. Read More

J Pediatr Gastroenterol Nutr 2022 Jul 20;75(1):81-87. Epub 2022 Apr 20.

From the Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA.

Objectives: Congenital portosystemic shunts (CPSS) are rare vascular malformations. We describe presentations, complications, associations, and outcomes of CPSS at Boston Children's Hospital (BCH).

Methods: This was a retrospective review of children with CPSS at BCH from 2000 to 2020. Read More

Eur Radiol 2022 Apr 20. Epub 2022 Apr 20.

Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangdong Province, Guangzhou, 510060, China.

Objectives: Portal vein tumour thrombus (PVTT)-related symptomatic portal hypertension (SPH) leads to a poor prognosis in hepatocellular carcinoma (HCC) patients. A transjugular intrahepatic portosystemic shunt (TIPS) can effectively relieve SPH but its effect remains unclear in PVTT-related SPH. This study aimed to evaluate the clinical value of the TIPS procedure combined with sequential systemic therapy in advanced HCC patients with PVTT-related SPH. Read More

Front Med (Lausanne) 2022 1;9:863596. Epub 2022 Apr 1.

Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.

Objective: Clinical evidence suggests that the risk stratification of portal hypertension (PH) plays a vital role in disease progression and patient outcomes. However, the gold standard for stratifying PH [portal vein pressure (PVP) measurement] is invasive and therefore not suitable for routine clinical practice. This study is aimed to stratify PH and predict patient outcomes using liver or spleen texture features based on computed tomography (CT) images non-invasively. Read More

Insights Imaging 2022 Apr 13;13(1):73. Epub 2022 Apr 13.

Department of Radiology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.

Background: TIPS is an established treatment for portal hypertension. The aim was to analyze how patient selection for TIPS implantation and procedural aspects have changed over 25 years. Routinely collected demographic, clinical, laboratory, and procedural data of 835 patients treated with TIPS in a single center were used. Read More

Hepatol Int 2022 Jun 5;16(3):658-668. Epub 2022 Apr 5.

Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectiology, University Hospital Muenster, 48149, Muenster, Germany.

Background And Aims: Transjugular intrahepatic portosystemic shunt (TIPS) implantation is an established procedure to treat portal hypertension. Impact of administration of aspirin on transplant-free survival after TIPS remains unknown.

Methods: A multicenter retrospective analysis including patients with TIPS implantation between 2011 and 2018 at three tertiary German Liver Centers was performed. Read More