The Role of the Transjugular Intrahepatic Porto-Systemic Shunt in an Emergency Setting
Abstract
:1. Introduction
2. Epidemiology and Outcomes of Emergency TIPSS
3. Pre-Procedural Work-Up
4. Indications for Emergency TIPSS
4.1. Esophageal Variceal Bleeding
4.2. Gastric Variceal Bleeding
4.3. Less Frequent Indications for Emergency TIPSS
4.3.1. Budd–Chiari Syndrome
4.3.2. Hepatorenal Syndrome
5. Timing of Emergency TIPSS
6. Technical Difficulties of Emergency TIPSS
7. Complication of Urgent TIPSS
7.1. Intraprocedural Complications
7.2. Early Postprocedural Complications
7.3. Delayed Postprocedural Complications
8. Discussion
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Lee, H.L.; Lee, S.W. The role of transjugular intrahepatic portosystemic shunt in patients with portal hypertension: Advantages and pitfalls. Clin. Mol. Hepatol. 2022, 28, 121–134. [Google Scholar] [CrossRef]
- Rösch, J.; Hanafee, W.N.; Snow, H. Transjugular portal venography and radiologic portacaval shunt: An experimental study. Radiology 1969, 92, 1112–1114. [Google Scholar] [CrossRef]
- Richter, G.M.; Palmaz, J.C.; Nöldge, G.; Rössle, M.; Siegerstetter, V.; Franke, M.; Wenz, W. Der transjuguläre intrahepatische portosystemische Stent-Shunt (TIPSS). Eine neue nichtoperative, perkutane Methode [The transjugular intrahepatic portosystemic stent-shunt. A new nonsurgical percutaneous method]. Radiologe 1989, 29, 406–411. [Google Scholar] [PubMed]
- Tripathi, D.; Stanley, A.J.; Hayes, P.C.; Travis, S.; Armstrong, M.J.; Tsochatzis, E.A.; Rowe, I.A.; Roslund, N.; Ireland, H.; Lomax, M.; et al. Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension. Gut 2020, 69, 1173–1192. [Google Scholar] [CrossRef] [PubMed]
- Inchingolo, R.; Posa, A.; Mariappan, M.; Tibana, T.K.; Nunes, T.F.; Spiliopoulos, S.; Brountzos, E. Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: A comprehensive review. World J. Gastroenterol. 2020, 34, 5060–5073. [Google Scholar] [CrossRef]
- Strunk, H.; Marinova, M. Transjugular Intrahepatic Portosystemic Shunt (TIPS): Pathophysiologic Basics, Actual Indications and Results with Review of the Literature. Transjugulärer intrahepatischer portosystemischer Stentshunt (TIPS): Pathophysiologische Grundlagen, gegenwärtige Indikationen und Ergebnisse mit Review der Literatur. RoFo Fortschr. Dem Geb. Rontgenstrahlen Nukl. 2018, 190, 701–711. [Google Scholar] [CrossRef] [Green Version]
- Vizzutti, F.; Schepis, F.; Arena, U.; Fanelli, F.; Gitto, S.; Aspite, S.; Turco, L.; Dragoni, G.; Laffi, G.; Marra, F. Transjugular intrahepatic portosystemic shunt (TIPS): Current indications and strategies to improve the outcomes. Intern. Emerg. Med. 2020, 15, 37–48. [Google Scholar] [CrossRef] [PubMed]
- Bañares, R.; Casado, M.; Rodríguez-Láiz, J.M.; Camúñez, F.; Matilla, A.; Echenagusía, A.; Simó, G.; Piqueras, B.; Clemente, G.; Cos, E. Urgent transjugular intrahepatic portosystemic shunt for control of acute variceal bleeding. Am. J. Gastroenterol. 1998, 93, 75–79. [Google Scholar] [CrossRef]
- Goykhman, Y.; Ben-Haim, M.; Rosen, G.; Carmiel-Haggai, M.; Oren, R.; Nakache, R.; Szold, O.; Klausner, J.; Kori, I. Transjugular intrahepatic portosystemic shunt: Current indications, patient selection and results. Isr. Med. Assoc. J. IMAJ 2010, 12, 687–691. [Google Scholar]
- Wong, Y.J.; Ho, W.L.D.; Abraldes, J.G. Pre-emptive TIPSS in Acute Variceal Bleeding: Current Status, Controversies, and Future Directions. J. Clin. Transl. Hepatol. 2022, 28, 1223–1228. [Google Scholar] [CrossRef]
- Thabut, D.; Pauwels, A.; Carbonell, N.; Remy, A.J.; Nahon, P.; Causse, X.; Cervoni, J.-P.; Cadranel, J.-F.; Archambeaud, I.; Bramli, S.; et al. Cirrhotic patients with portal hypertension-related bleeding and an indication for early-TIPS: A large multicentre audit with real-life results. J. Hepatol. 2018, 68, 73–81. [Google Scholar] [CrossRef] [PubMed]
- Dunne, P.D.J.; Sinha, R.; Stanley, A.J.; Lachlan, N.; Ireland, H.; Shams, A.; Kasthuri, R.; Forrest, E.H.; Hayes, P.C. Randomised clinical trial: Standard of care versus early-transjugular intrahepatic porto-systemic shunt (TIPSS) in patients with cirrhosis and oesophageal variceal bleeding. Aliment. Pharmacol. Ther. 2020, 52, 98–106. [Google Scholar] [CrossRef]
- Zhu, Y.; Wang, X.; Xi, X.; Li, X.; Luo, X.; Yang, L. Emergency Transjugular Intrahepatic Portosystemic Shunt: An Effective and Safe Treatment for Uncontrolled Variceal Bleeding. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract 2019, 23, 2193–2200. [Google Scholar] [CrossRef] [PubMed]
- Boyer, T.D.; Haskal, Z.J.; American Association for the Study of Liver Diseases. The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Hepatology 2005, 41, 386–400. [Google Scholar] [CrossRef] [PubMed]
- Copelan, A.; Kapoor, B.; Sands, M. Transjugular intrahepatic portosystemic shunt: Indications, contraindications, and patient work-up. Semin. Interv. Radiol. 2014, 31, 235–242. [Google Scholar] [CrossRef] [Green Version]
- Addley, J.; Tham, T.C.; Cash, W.J. Use of portal pressure studies in the management of variceal haemorrhage. World J. Gastrointest. Endosc. 2012, 4, 281–289. [Google Scholar] [CrossRef]
- Hernández-Gea, V.; Berbel, C.; Baiges, A.; García-Pagán, J.C. Acute variceal bleeding: Risk stratification and management (including TIPS). Hepatol. Int. 2018, 12, 81–90. [Google Scholar] [CrossRef]
- Hung, M.L.; Lee, E.W. Role of Transjugular Intrahepatic Portosystemic Shunt in the Management of Portal Hypertension: Review and Update of the Literature. Clin. Liver Dis. 2019, 23, 737–754. [Google Scholar] [CrossRef]
- de Franchis, R. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J. Hepatol. 2015, 63, 743–752. [Google Scholar] [CrossRef] [Green Version]
- Sarin, S.K.; Kumar, A.; Almeida, J.A.; Chawla, Y.K.; Fan, S.T.; Garg, H.; de Silva, H.J.; Hamid, S.S.; Jalan, R.; Komolmit, P.; et al. Acute-on-chronic liver failure: Consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol. Int. 2009, 3, 269–282. [Google Scholar] [CrossRef]
- García-Pagán, J.C.; Caca, K.; Bureau, C.; Laleman, W.; Appenrodt, B.; Luca, A.; Abraldes, J.G.; Nevens, F.; Vinel, J.P.; Mössner, J.; et al. Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group. Early use of TIPS in patients with cirrhosis and variceal bleeding. N. Engl. J. Med. 2010, 362, 2370–2379. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Monescillo, A.; Martínez-Lagares, F.; Ruiz-del-Arbol, L.; Sierra, A.; Guevara, C.; Jiménez, E.; Marrero, J.M.; Buceta, E.; Sánchez, J.; Castellot, A.; et al. Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding. Hepatology 2004, 40, 793–801. [Google Scholar] [CrossRef] [PubMed]
- Loffroy, R.; Favelier, S.; Pottecher, P.; Estivalet, L.; Genson, P.Y.; Gehin, S.; Krausé, D.; Cercueil, J.P. Transjugular intrahepatic portosystemic shunt for acute variceal gastrointestinal bleeding: Indications, techniques and outcomes. Diagn. Interv. Imaging 2015, 96, 745–755. [Google Scholar] [CrossRef] [PubMed]
- Zanetto, A.; Garcia-Tsao, G. Management of acute variceal hemorrhage. F1000Research 2019, 8, F1000 Faculty Rev-966. [Google Scholar] [CrossRef]
- Nicoară-Farcău, O.; Han, G.; Rudler, M.; Angrisani, D.; Monescillo, A.; Torres, F.; Casanovas, G.; Bosch, J.; Lv, Y.; Thabut, D.; et al. Preemptive TIPS Individual Data Metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups. Effects of Early Placement of Transjugular Portosystemic Shunts in Patients with High-Risk Acute Variceal Bleeding: A Meta-analysis of Individual Patient Data. Gastroenterology 2021, 160, 193–205. [Google Scholar] [CrossRef]
- Vine, L.J.; Subhani, M.; Acevedo, J.G. Update on management of gastric varices. World J. Hepatol. 2019, 11, 250–260. [Google Scholar] [CrossRef]
- Park, E.J.; Jang, J.Y.; Lee, J.E.; Jeong, S.W.; Lee, S.H.; Kim, S.G.; Cha, S.W.; Kim, Y.S.; Cho, Y.D.; Cho, J.Y.; et al. The risk factors for bleeding of fundal varices in patients with liver cirrhosis. Gut Liver 2013, 7, 704–711. [Google Scholar] [CrossRef] [Green Version]
- Barange, K.; Péron, J.M.; Imani, K.; Otal, P.; Payen, J.L.; Rousseau, H.; Pascal, J.P.; Joffre, F.; Vinel, J.P. Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices. Hepatology 1999, 30, 1139–1143. [Google Scholar] [CrossRef]
- Chau, T.N.; Patch, D.; Chan, Y.W.; Nagral, A.; Dick, R.; Burroughs, A.K. “Salvage” transjugular intrahepatic portosystemic shunts: Gastric fundal compared with esophageal variceal bleeding. Gastroenterology 1998, 114, 981–987. [Google Scholar] [CrossRef]
- Procaccini, N.J.; Al-Osaimi, A.M.; Northup, P.; Argo, C.; Caldwell, S.H. Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: A single-center U.S. analysis. Gastrointest. Endosc. 2009, 70, 881–887. [Google Scholar] [CrossRef]
- Henry, Z.; Patel, K.; Patton, H.; Saad, W. AGA Clinical Practice Update on Management of Bleeding Gastric Varices: Expert Review. Clin. Gastroenterol. Hepatol. 2021, 19, 1098–1107. [Google Scholar] [CrossRef]
- Bizollon, T.; Dumortier, J.; Jouisse, C.; Rode, A.; Henry, L.; Boillot, O.; Valette, P.J.; Ducerf, C.; Souquet, J.C.; Baulieux, J.; et al. Transjugular intra-hepatic portosystemic shunt for refractory variceal bleeding. Eur. J. Gastroenterol. Hepatol. 2001, 13, 369–375. [Google Scholar] [CrossRef] [PubMed]
- Lv, Y.; Chen, H.; Luo, B.; Bai, W.; Li, K.; Wang, Z.; Xia, D.; Guo, W.; Wang, Q.; Li, X.; et al. Transjugular intrahepatic portosystemic shunt with or without gastro-oesophageal variceal embolisation for the prevention of variceal rebleeding: A randomised controlled trial. Lancet Gastroenterol. Hepatol. 2022, 7, 736–746. [Google Scholar] [CrossRef] [PubMed]
- Sharma, A.; Keshava, S.N.; Eapen, A.; Elias, E.; Eapen, C.E. An Update on the Management of Budd-Chiari Syndrome. Dig. Dis. Sci. 2021, 66, 1780–1790. [Google Scholar] [CrossRef] [PubMed]
- Angeli, P.; Ginès, P.; Wong, F.; Bernardi, M.; Boyer, T.D.; Gerbes, A.; Moreau, R.; Jalan, R.; Sarin, S.K.; Piano, S.; et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: Revised consensus recommendations of the International Club of Ascites. J. Hepatol. 2015, 62, 968–974, Erratum in J. Hepatol. 2015, 63, 290. [Google Scholar] [CrossRef] [Green Version]
- Garcia-Pagán, J.C.; Heydtmann, M.; Raffa, S.; Plessier, A.; Murad, S.; Fabris, F.; Vizzini, G.; Gonzales Abraldes, J.; Olliff, S.; Nicolini, A.; et al. Budd-Chiari Syndrome-Transjugular Intrahepatic Portosystemic Shunt Group. TIPS for Budd-Chiari syndrome: Long-term results and prognostics factors in 124 patients. Gastroenterology 2008, 135, 808–815. [Google Scholar] [CrossRef]
- Blum, U.; Rössle, M.; Haag, K.; Ochs, A.; Blum, H.E.; Hauenstein, K.H.; Astinet, F.; Langer, M. Budd-Chiari syndrome: Technical, hemodynamic, and clinical results of treatment with transjugular intrahepatic portosystemic shunt. Radiology 1995, 197, 805–811. [Google Scholar] [CrossRef]
- Molmenti, E.P.; Segev, D.L.; Arepally, A.; Hong, J.; Thuluvath, P.J.; Rai, R.; Klein, A.S. The utility of TIPS in the management of Budd-Chiari syndrome. Ann. Surg. 2005, 241, 978–981. [Google Scholar] [CrossRef]
- Amin, A.A.; Alabsawy, E.I.; Jalan, R.; Davenport, A. Epidemiology, Pathophysiology, and Management of Hepatorenal Syndrome. Semin. Nephrol. 2019, 39, 17–30. [Google Scholar] [CrossRef] [Green Version]
- Piano, S.; Tonon, M.; Angeli, P. Management of ascites and hepatorenal syndrome. Hepatol. Int. 2018, 12, 122–134. [Google Scholar] [CrossRef]
- Brensing, K.A.; Textor, J.; Perz, J.; Schiedermaier, P.; Raab, P.; Strunk, H.; Klehr, H.U.; Kramer, H.J.; Spengler, U.; Schild, H.; et al. Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: A phase II study. Gut 2000, 47, 288–295. [Google Scholar] [CrossRef] [PubMed]
- Loffroy, R.; Estivalet, L.; Cherblanc, V.; Favelier, S.; Pottecher, P.; Hamza, S.; Minello, A.; Hillon, P.; Thouant, P.; Lefevre, P.H.; et al. Transjugular intrahepatic portosystemic shunt for the management of acute variceal hemorrhage. World J. Gastroenterol. 2013, 19, 6131–6143. [Google Scholar] [CrossRef] [PubMed]
- Garcia-Tsao, G.; Abraldes, J.G.; Berzigotti, A.; Bosch, J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017, 65, 310–335. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Rossle, M. When endoscopic therapy or pharmacotherapy fails to control variceal bleeding: What should be done? Immediate control of bleeding by TIPS? Langenbecks Arch. Surg. 2003, 388, 155–162. [Google Scholar] [CrossRef]
- Owen, A.R.; Stanley, A.J.; Vijayananthan, A.; Moss, J.G. The transjugular intrahepatic portosystemic shunt (TIPS). Clin. Radiol. 2009, 64, 664–674. [Google Scholar] [CrossRef]
- Patidar, K.R.; Sydnor, M.; Sanyal, A.J. Transjugular intrahepatic portosystemic shunt. Clin. Liver Dis. 2014, 18, 853–876. [Google Scholar] [CrossRef] [Green Version]
- Qiu, Z.; Zhu, W.; Yan, H.; Wang, G.; Zuo, M.; Qi, H.; Wang, G.; Jiang, W.; Xue, J.; Zhang, F.; et al. Single-Centre Retrospective Study Using Propensity Score Matching Comparing Left Versus Right Internal Jugular Vein Access for Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation. Cardiovasc. Interv. Radiol. 2022, 45, 563–569. [Google Scholar] [CrossRef]
- Kusminsky, R.E. Complications of central venous catheterization. J. Am. Coll. Surg. 2007, 204, 681–696. [Google Scholar] [CrossRef]
- Shah, R.P.; Sze, D.Y. Complications During Transjugular Intrahepatic Portosystemic Shunt Creation. Tech. Vasc. Interv. Radiol. 2016, 19, 61–73. [Google Scholar] [CrossRef]
- Partovi, S.; Li, X.; Shwaiki, O.; Rashwan, B.; Ruff, C.; Grozinger, G.; Gadani, S.; Szaflarski, D.; Thompson, D.; D’Amico, G.; et al. Advanced portal venous access techniques for transjugular intrahepatic portosystemic shunt placement. BMJ Open Gastroenterol. 2021, 8, e000815. [Google Scholar] [CrossRef]
- Erbay, N.; Raptopoulos, V.; Pomfret, E.A. Living donor liver transplantation in adults: Vascular variants important in surgical planning for donors and recipients. Am. J. Roentgenol. 2003, 181, 109–114. [Google Scholar] [CrossRef] [PubMed]
- Hidajat, N.; Kreuschner, M.; Röttgen, R.; Schröder, R.J.; Schmidt, S.; Felix, R. Placement of transjugular intrahepatic portosystemic shunt via the left hepatic vein under sonographic guidance in a patient with right hemihepatectomy. Acta Radiol. 2003, 44, 363–365. [Google Scholar] [CrossRef]
- Gaba, R.C.; Khiatani, V.L.; Knuttinen, M.G.; Omene, B.O.; Carrillo, T.C.; Bui, J.T.; Owens, C.A. Comprehensive review of TIPS technical complications and how to avoid them. AJR Am. J. Roentgenol. 2011, 196, 675–685. [Google Scholar] [CrossRef] [PubMed]
- Fidelman, N.; Kwan, S.W.; LaBerge, J.M.; Gordon, R.L.; Ring, E.J.; Kerlan, R.K., Jr. The transjugular intrahepatic portosystemic shunt: An update. AJR Am. J. Roentgenol. 2012, 199, 746–755. [Google Scholar] [CrossRef] [PubMed]
- González-Abraldes, J.; Moitinho, E.; García-Pagán, J.C.; Escorsell, A.; Salmerón, J.M.; Gilabert, R.; Real, M.; Muntanyá, X.; Bosch, J. Selective arterial embolization for life threatening hemobilia after transjugular intrahepatic portosystemic shunt placement. J. Hepatol. 2001, 34, 174–176. [Google Scholar] [CrossRef] [PubMed]
- Haskal, Z.J.; Pentecost, M.J.; Rubin, R.A. Hepatic arterial injury after transjugular intrahepatic portosystemic shunt placement: Report of two cases. Radiology 1993, 188, 85–88. [Google Scholar] [CrossRef]
- Suhocki, P.V.; Lungren, M.P.; Kapoor, B.; Kim, C.Y. Transjugular intrahepatic portosystemic shunt complications: Prevention and management. Semin. Interv. Radiol. 2015, 32, 123–132. [Google Scholar] [CrossRef] [Green Version]
- Liu, K.; Fan, X.X.; Wang, X.L.; He, C.S.; Wu, X.J. Delayed liver laceration following transjugular intrahepatic portosystemic shunt for portal hypertension. World J. Gastroenterol. 2012, 18, 7405–7408. [Google Scholar] [CrossRef]
- Terreni, N.; Vangeli, M.; Raimondo, M.L.; Tibballs, J.M.; Patch, D.; Burroughs, A.K. Late intrahepatic hematoma complicating transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome. Cardiovasc. Interv. Radiol. 2007, 30, 1065–1069. [Google Scholar] [CrossRef]
- Fickert, P.; Trauner, M.; Hausegger, K.; Tauss, J.; Lackner, H.; Krejs, G.J.; Stauber, R.E. Intra-hepatic hematoma complicating transjugular intra-hepatic portosystemic shunt for Budd-Chiari syndrome associated with anti-phospholipid antibodies, aplastic anemia and chronic hepatitis C. Eur. J. Gastroenterol. Hepatol. 2000, 12, 813–816. [Google Scholar] [CrossRef]
- Rose, C.F.; Amodio, P.; Bajaj, J.S.; Dhiman, R.K.; Montagnese, S.; Taylor-Robinson, S.D.; Vilstrup, H.; Jalan, R. Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy. J. Hepatol. 2020, 73, 1526–1547. [Google Scholar] [CrossRef]
- Fu, J.; Gao, Y.; Shi, L. Combination therapy with rifaximin and lactulose in hepatic encephalopathy: A systematic review and meta-analysis. PLoS ONE 2022, 17, e0267647. [Google Scholar] [CrossRef] [PubMed]
- Kavitt, R.T.; Yang, V.L.; Jensen, D.M. Cerebral edema and hyperammonemia after transjugular intrahepatic portosystemic shunt placement in a cirrhotic patient. Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc. 2008, 6, 1054–1056. [Google Scholar] [CrossRef] [PubMed]
- Joseph, A.S.; Sandhu, B.; Khalil, A.; Lopera, J. Transjugular Portosystemic Shunt Reductions: A Retrospective Single-Center Experience. J. Vasc. Interv. Radiol. 2019, 30, 876–884. [Google Scholar] [CrossRef] [PubMed]
- Madoff, D.C.; Wallace, M.J.; Ahrar, K.; Saxon, R.R. TIPS-related hepatic encephalopathy: Management options with novel endovascular techniques. Radiogr. A Rev. Publ. Radiol. Soc. N. Am. Inc. 2004, 24, 21–37. [Google Scholar] [CrossRef]
- Fanelli, F.; Salvatori, F.M.; Rabuffi, P.; Boatta, E.; Riggio, O.; Lucatelli, P.; Passariello, R. Management of refractory hepatic encephalopathy after insertion of TIPS: Long-term results of shunt reduction with hourglass-shaped balloon-expandable stent-graft. AJR Am. J. Roentgenol. 2009, 193, 1696–1702. [Google Scholar] [CrossRef]
- Pattynama, P.M.; Wils, A.; van der Linden, E.; van Dijk, L.C. Embolization with the Amplatzer Vascular Plug in TIPS patients. Cardiovasc. Interv. Radiol. 2007, 30, 1218–1221. [Google Scholar] [CrossRef] [Green Version]
- Paz-Fumagalli, R.; Crain, M.R.; Mewissen, M.W.; Varma, R.R. Fatal hemodynamic consequences of therapeutic closure of a transjugular intrahepatic portosystemic shunt. JVIR 1994, 5, 831–834. [Google Scholar] [CrossRef]
- Intagliata, N.M.; Caldwell, S.H.; Tripodi, A. Diagnosis, Development, and Treatment of Portal Vein Thrombosis in Patients with and without Cirrhosis. Gastroenterology 2019, 156, 1582–1599. [Google Scholar] [CrossRef]
- Sze, D.Y.; Vestring, T.; Liddell, R.P.; Kato, N.; Semba, C.P.; Razavi, M.K.; Kee, S.T.; Dake, M.D. Recurrent TIPS failure associated with biliary fistulae: Treatment with PTFE-covered stents. Cardiovasc. Interv. Radiol. 1999, 22, 298–304. [Google Scholar] [CrossRef]
- Perarnau, J.M.; Le Gouge, A.; Nicolas, C.; D’Alteroche, L.; Borentain, P.; Saliba, F.; Minello, A.; Anty, R.; Chagneau-Derrode, C.; Bernard, P.H.; et al. Covered vs. uncovered stents for transjugular intrahepatic portosystemic shunt: A randomized controlled trial. J. Hepatol. 2014, 60, 962–968. [Google Scholar] [CrossRef] [PubMed]
- Chen, S.; Li, X.; Wei, B.; Tong, H.; Zhang, M.G.; Huang, Z.Y.; Cao, J.W.; Tang, C.W. Recurrent variceal bleeding and shunt patency: Prospective randomized controlled trial of transjugular intrahepatic portosystemic shunt alone or combined with coronary vein embolization. Radiology 2013, 268, 900–906. [Google Scholar] [CrossRef]
- Wang, X.; Luo, X.; Zhao, M.; Song, J.; Li, X.; Yang, L. Prognostic Factors for Acute Transjugular Intrahepatic Portosystemic Shunt Occlusion Using Expanded Polytetrafluoroethylene-Covered Stent. Dig. Dis. Sci. 2020, 65, 3032–3039. [Google Scholar] [CrossRef]
- Müller-Hülsbeck, S.; Höpfner, M.; Hilbert, C.; Krämer-Hansen, H.; Heller, M. Mechanical thrombectomy of acute thrombosis in transjugular intrahepatic portosystemic shunts. Investig. Radiol. 2000, 35, 385–391. [Google Scholar] [CrossRef] [PubMed]
- Wolf, D.C.; Siddiqui, S.; Rayyan, Y.; Rozenblit, G. Emergent stent occlusion for TIPS-induced liver failure. Dig. Dis. Sci. 2005, 50, 2356–2358. [Google Scholar] [CrossRef] [PubMed]
- López-Méndez, E.; Zamora-Valdés, D.; Díaz-Zamudio, M.; Fernández-Díaz, O.F.; Avila, L. Liver failure after an uncovered TIPS procedure associated with hepatic infarction. World J. Hepatol. 2010, 2, 167–170. [Google Scholar] [CrossRef]
- Chung, H.H.; Razavi, M.K.; Sze, D.Y.; Frisoli, J.K.; Kee, S.T.; Dake, M.D.; Hellinger, J.C.; Kang, B.C. Portosystemic pressure gradient during transjugular intrahepatic portosystemic shunt with Viatorr stent graft: What is the critical low threshold to avoid medically uncontrolled low pressure gradient related complications? J. Gastroenterol. Hepatol. 2008, 23, 95–101. [Google Scholar] [CrossRef] [PubMed]
- Fehervari, I.; Szonyi, L.; Fazakas, J.; Gerlei, Z.; Lazar, I. TIPS stent migration into the heart with 6-year follow-up. Ann. Transplant. 2011, 16, 109–112. [Google Scholar] [CrossRef]
- Gazzera, C.; Righi, D.; Doriguzzi Breatta, A.; Rossato, D.; Camerano, F.; Valle, F.; Gandini, G. Emergency transjugular intrahepatic portosystemic shunt (TIPS): Results, complications and predictors of mortality in the first month of follow-up. Radiol. Med. 2012, 117, 46–53. [Google Scholar] [CrossRef]
- Kochar, N.; Tripathi, D.; Arestis, N.J.; Ireland, H.; Redhead, D.N.; Hayes, P.C. Tipsitis: Incidence and outcome-a single centre experience. Eur. J. Gastroenterol. Hepatol. 2010, 22, 729–735. [Google Scholar] [CrossRef]
- Vangeli, M.; Patch, D.; Burroughs, A.K. Salvage tips for uncontrolled variceal bleeding. J. Hepatol. 2002, 37, 703–704. [Google Scholar] [CrossRef] [PubMed]
- Luo, X.; Wang, Z.; Tsauo, J.; Zhou, B.; Zhang, H.; Li, X. Advanced Cirrhosis Combined with Portal Vein Thrombosis: A Randomized Trial of TIPS versus Endoscopic Band Ligation Plus Propranolol for the Prevention of Recurrent Esophageal Variceal Bleeding. Radiology 2015, 276, 286–293. [Google Scholar] [CrossRef] [PubMed]
- Maimone, S.; Saffioti, F.; Filomia, R. Predictors of Re-bleeding and Mortality Among Patients with Refractory Variceal Bleeding Undergoing Salvage Transjugular Intrahepatic Portosystemic Shunt (TIPS). Dig. Dis. Sci. 2019, 64, 1335–1345. [Google Scholar] [CrossRef] [Green Version]
- Vidal, V.; Joly, L.; Perreault, P.; Bouchard, L.; Lafortune, M.; Pomier-Layrargues, G. Usefulness of transjugular intrahepatic portosystemic shunt in the management of bleeding ectopic varices in cirrhotic patients. Cardiovasc. Interv. Radiol. 2006, 29, 216–219. [Google Scholar] [CrossRef] [PubMed]
- ter Borg, P.C.; Hollemans, M.; Van Buuren, H.R.; Vleggaar, F.P.; Groeneweg, M.; Hop, W.C.; Laméris, J.S. Transjugular intrahepatic portosystemic shunts: Long-term patency and clinical results in a patient cohort observed for 3–9 years. Radiology 2004, 231, 537–545. [Google Scholar] [CrossRef]
- Escorsell, À.; Pavel, O.; Cárdenas, A.; Morillas, R.; Llop, E.; Villanueva, C.; Garcia-Pagán, J.C.; Bosch, J. Variceal Bleeding Study Group. Esophageal balloon tamponade versus esophageal stent in controlling acute refractory variceal bleeding: A multicenter randomized, controlled trial. Hepatology 2016, 63, 1957–1967. [Google Scholar] [CrossRef] [Green Version]
- Marot, A.; Trépo, E.; Doerig, C.; Moreno, C.; Deltenre, P. Self-expanding metal stent should be considered in patients with cirrhosis and uncontrolled variceal bleeding. Hepatology 2016, 64, 22–73. [Google Scholar] [CrossRef] [Green Version]
- Guo, D.F.; Fan, L.W.; Le, Q.; Huang, C.B. Transjugular intrahepatic portosystemic shunt for the prevention of rebleeding in patients with cirrhosis and portal vein thrombosis: Systematic review and meta-analysis. Front. Pharmacol. 2022, 13, 968–988. [Google Scholar] [CrossRef]
- Weichselbaum, L.; Lepida, A.; Marot, A.; Trépo, E.; Moreno, C.; Deltenre, P. Salvage transjugular intrahepatic portosystemic shunt in patients with cirrhosis and refractory variceal bleeding: A systematic review with meta-analysis. United Eur. Gastroenterol. J. 2022, 10, 874–887. [Google Scholar] [CrossRef]
- Lv, Y.; Yang, Z.; Liu, L.; Li, K.; He, C.; Wang, Z.; Bai, W.; Guo, W.; Yu, T.; Yuan, X.; et al. Early TIPS with covered stents versus standard treatment for acute variceal bleeding in patients with advanced cirrhosis: A randomised controlled trial. Lancet Gastroenterol. Hepatol. 2019, 4, 587–598. [Google Scholar] [CrossRef]
- Urata, J.; Yamashita, Y.; Tsuchigame, T.; Hatanaka, Y.; Matsukawa, T.; Sumi, S.; Matsuno, Y.; Takahashi, M. The effects of transjugular intrahepatic portosystemic shunt on portal hypertensive gastropathy. J. Gastroenterol. Hepatol. 1998, 13, 1061–1067. [Google Scholar] [CrossRef] [PubMed]
- Rössle, M.; Ochs, A.; Gülberg, V.; Siegerstetter, V.; Holl, J.; Deibert, P.; Olschewski, M.; Reiser, M.; Gerbes, A.L. A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N. Engl. J. Med. 2000, 342, 1701–1707. [Google Scholar] [CrossRef] [PubMed]
- Rajesh, S.; George, T.; Philips, C.A.; Ahamed, R.; Kumbar, S.; Mohan, N.; Mohanan, M.; Augustine, P. Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update. World J. Gastroenterol. 2020, 26, 5561–5596. [Google Scholar] [CrossRef] [PubMed]
Absolute | Relative |
---|---|
Congestive heart failure [15] | Portal vein thrombosis [14] |
Severe tricuspidal regurgitation [15] | Severe coagulopathy [15] |
Severe pulmonary hypertension [15] | Hepatic encephalopathy [14] |
Severe systemic sepsis [14] | Hepatocellular carcinoma [14] |
Unrelieved biliary obstruction [14] | Budd–Chiari syndrome [14] |
Acute Variceal Bleeding | Budd–Chiari Syndrome | Hepato-Renal Syndrome |
---|---|---|
First-line therapy: drugs plus endoscopy (unsuccessful in 15–20% of AVB) [17] | First-line therapy: anticoagulants +/− hepatic vein angioplasty or stenting | TIPSS decreases renin and aldosterone plasma levels, increasing GFR and salt excretion [39] |
TIPSS recommended for PH-related AVB (AVB control in 90% of cases) [18] | TIPSS considered in case of significant hepatic vein obstruction (HVPG reduction in 75% of cases) [35,37] | Increase in 3-month OS [41] |
Significant symptoms improvement in patients with HVPG > 20 mmHg with similar HE incidence [21,22] | Lack of literature data | Lack of literature data |
Intraprocedural | Early Postprocedural | Delayed Postprocedural |
---|---|---|
Hemoperitoneum [51] | Liver rupture [56] | Stent migration [78] |
Artery thrombosis [53] | Hepatic encephalopathy [61] | Endotipsitis [80] |
Porto-biliary fistula [51] | Early stent occlusion [69] | Variceal rebleeding [81] |
Lesion adjacent organs [51] | Liver failure [76] | Late stent blockage [83] |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Posa, A.; Tenore, L.; Barbieri, P.; Mazza, G.; Sala, E.; Iezzi, R. The Role of the Transjugular Intrahepatic Porto-Systemic Shunt in an Emergency Setting. Life 2023, 13, 868. https://doi.org/10.3390/life13040868
Posa A, Tenore L, Barbieri P, Mazza G, Sala E, Iezzi R. The Role of the Transjugular Intrahepatic Porto-Systemic Shunt in an Emergency Setting. Life. 2023; 13(4):868. https://doi.org/10.3390/life13040868
Chicago/Turabian StylePosa, Alessandro, Lorenzo Tenore, Pierluigi Barbieri, Giulia Mazza, Evis Sala, and Roberto Iezzi. 2023. "The Role of the Transjugular Intrahepatic Porto-Systemic Shunt in an Emergency Setting" Life 13, no. 4: 868. https://doi.org/10.3390/life13040868
APA StylePosa, A., Tenore, L., Barbieri, P., Mazza, G., Sala, E., & Iezzi, R. (2023). The Role of the Transjugular Intrahepatic Porto-Systemic Shunt in an Emergency Setting. Life, 13(4), 868. https://doi.org/10.3390/life13040868