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Transjugular intrahepatic portosystemic shunt (TIPS) is a safe and effective method for the treatment of portal hypertension complications in patients with decompensated liver cirrhosis. At present, there are many prognostic scoring tools for risk stratification of poor prognosis after TIPS. This article briefly introduces seven prognostic scoring tools commonly used for TIPS and summarizes the clinical research evidence of each scoring tool. The literature review shows that there is currently no sufficient research evidence to determine the optimal prognostic scoring tool after TIPS. Future clinical studies should comprehensively explore the advantages and disadvantages of different scoring tools in predicting short- and long-term adverse prognostic events after TIPS and develop new prognostic scoring tools in combination with new prognostic markers.
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Objective To investigate the influence of the stent position in transjugular intrahepatic left branch of portal vein portosystemic shunt (TILPS) on the long-term effect.Methods The clinical data of 527 patients with upper gastrointestinal bleeding duo to portal hypertension,who were treated with TILPS during the the period from January 2012 to December 2014,were retrospectively analyzed.According to whether the stent was placed into the left branch of portal vein,the patients were divided into the study group (stent in the left branch of portal vein,n=318) and the control group (stent in the main portal vein,n=209).The success rate of surgery,the shunt channel flow dynamics,the stent patency rate,the incidence of hepatic encephalopathy,the rate of re-bleeding,etc.were compared between the two groups.Results The success rate of shunting operation was 100％ in both groups.One year after the treatment,the blood velocity and flow parameters in the shunt channel of the study group were significantly higher than those of the control group (P＜0.05).During the the follow-up period lasting for one year,the incidences of shunt channel dysfunction in the study group and in the control group were 1.26％ (4/318) and 5.74％ (12/209) respectively (P=0.003),the incidences of hepatic encephalopathy in the study group and in the control group were 0.31％ (1/318) and 4.31％ (9/209) respectively (P=0.001),and the incidences of re-bleeding in the study group and in the control group were 0.94％ (3/318) and 2.87％ (6/209) respectively (P=0.095).Conclusion During the performance of TIPS,the puncture of the left branch of portal vein and placement of the stent in the left branch of portal vein can reduce both the incidence of shunt channel dysfunction and the incidence of hepatic encephalopathy.
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Objective To study the pathogenesis of upper gastrointestinal rehaemorrhagia after the transjugular intrahepatic portasystemic shunt (TIPS) and its influencing factor.Methods Fifty postoperative patients with TIPS were selected.The patients were followed-up,and the effect of the various factors in the role of upper gastrointestinal rehaemorrhagia after TIPS was analyzed.Results The portal vein pressure of 50 patients with TIPS decreased from preoperative (39.8 ±9.2) cmH2O (1 cmH2O =0.098 kPa) to postoperative (25.2 ± 5.8) cmH2O,and there was statistical difference (P ＜ 0.05).Fourteen patients appeared upper gastrointestinal rehaemorrhagia after TIPS,which accounted for total of 28％ (14/50) and included 3 cases of postoperative vomiting blood within 3 days.Acute stomach mucosa lesions bleeding was considered,and bleeding was controlled within a short-term medical treatment (1 patient after more than a year in recurrent upper gastrointestinal rehaemorrhagia).Twelve cases of patients appeared upper gastrointestinal rehaemorrhagia within 2 years after TIPS,and the causes of rehaemorrhagia in 6 cases were esophageal variceal rehaemorrhagia,gastric and duodenal ulcer in 3 cases,erosive gastritis in 2 cases,coagulation abnormalities in 1 case.Esophageal variceal rehaemorrhagia rate was 12％ (6/50).Conclusions The main reasons of upper gastrointestinal rehaemorrhagia after TIPS are variceal rehaemorrhagia and non variceal rehaemorrhagia,both of which are important causes of rehaemorrhagia after TIPS.Variceal rehaemorrhagia after TIPS occurs more than 3 months,and non variceal rehaemorrhagia occurs within 3months,so it is very important to protect gastric mucosa with proton pump inhibitor in postoperative patients.
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<p><b>OBJECTIVE</b>To determine and analyze plasma ammonia concentration difference of the portal vein system and ramifications of rabbits and consequently guide selection of the portal vein in transjugular intrahepatic portosystemic shunt (TIPS) so that reduce shunt-induced hepatic encephalopathic incidence. To evaluate clinical significance of transjugular intrahepatic left branch of portal vein portosystemic shunt (TILPS) and to analyse hemodynamics of both branches of the portal vein and to observe long-term results in the prevention of encephalopathy.</p><p><b>METHODS</b>Blood samples in different portal vein branches of rabbits were collected and the plasma ammonia concentration was assayed and compared. The left branch of portal vein was used as the puncture site to perform TILPS and to keep away from the right branch of portal vein blood that contains nutrition and toxin.</p><p><b>RESULTS</b>Plasma ammonia content was superior in the mesenteric vein and higher than the portal vein branch, the splenic vein, and the vena cava. The right portal vein was above the left. Encephalopathy did not occur in all patients within 3 months. Of the 341 patients undergoing TILPS, encephalopathy occurred in only 5 patients (1.47%) and shunt abnormalities in 19 patients (5.57%) verified by venography during overall follow-up period.</p><p><b>CONCLUSIONS</b>Selective left branch of the portal vein portosystemic shunt can decrease encephalopathy obviously and protect liver function.</p>
Subject(s)
Adult , Aged , Animals , Female , Humans , Male , Middle Aged , Rabbits , Ammonia , Blood , Follow-Up Studies , Hepatic Encephalopathy , Blood , Portal Vein , General Surgery , Portasystemic Shunt, Transjugular Intrahepatic , Treatment OutcomeABSTRACT
Purpose:To assess the security and efficacy of mechanical recanalization and stenting of lilac arteries with complete occlusions without preceding thrombolytic therapy. Materials and methods:During a 3-year period,Eighteen consecutive patients underwent mechanical reeanalization and stenting for complete occlusion of the iliac artery.The method involved recanalizition with a guide wire and a catheter advanced as a while unit through the occluded segment(snowplow technique).Results The occluded segments were successfully traversed and dilated and 32 stents were placed in 18 patients.The mean ankle-brachial index (BAI)increased from 0.39?0.33 before the procedure to 0.86?0.13 after the procedure(P
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Objective To investigate into the indications and related anatomic foundation of transjugular intrahepatic portosystemic shunt(TIPS) creation by direct transcaval approach in patients with portal hypertension cirrhosis suffering unusual anatomy between the hepatic veins and portal bifurcation; and to evaluate the security, feasibility and clinical significance. Methods Direct transcaval approach TIPS were performed in 65 patients including active variceal bleeding (n=52), intractable ascites (n=12), and as a bridge to liver transplantation (n=1). Results Technical and functional success were achieved in all patients. The success rate was 100% without related complications including the technique and primary patency rate is obvious higher than classical TIPS. Conclusion In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is secure and feasible. The results suggest that the direct transcaval approach offering favorable primary patency because the shunt has a straight line in construction.