nach oben

Current Gastroenterology Reports

Erschienen in:

21.08.2023

TIPS: indications, Contraindications, and Evaluation

verfasst von: Allison Carroll, Justin R. Boike

Erschienen in: Current Gastroenterology Reports | Ausgabe 10/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

This review summarizes the current and emerging indications, contraindications, and evaluation for TIPS. In the last three decades of use, there have been substantial changes and progress in this field, including the use of controlled-expansion, covered stents, which has broadened the clinical uses of TIPS.

Recent Findings

Recent findings have rapidly expanded the indications for TIPS, including emerging uses in hepatorenal syndrome, hepatopulmonary syndrome and before abdominal surgery. The widespread use of controlled-expansion, covered stents has decreased rates of post-TIPS hepatic encephalopathy, opening TIPS to a larger patient population.

Summary

Overall, with newer stent technology and more research in this area, the clinical utility and potential of TIPS has rapidly expanded. Going forward, a renewed focus on randomized-control trials and long-term outcomes will be a crucial element to selecting appropriate TIPS recipients and recommending emerging indications for this procedure.

Mauro E, Gadano A. What’s new in portal hypertension? Liver Int. 2020;40(S1):122–7. https://doi.org/10.1111/liv.14366.CrossRefPubMed

Rössle M, Richter GM, Nöldge G, Palmaz JC, Wenz W, Gerok W. New non-operative treatment for variceal haemorrhage. Lancet. 1989;2(8655):153. https://doi.org/10.1016/s0140-6736(89)90201-8.CrossRefPubMed

Praktiknjo M, Abu-Omar J, Chang J, Thomas D, Jansen C, Kupczyk P, et al. Controlled underdilation using novel VIATORR® controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation. JHEP Rep. 2021;3(3):100264. https://doi.org/10.1016/j.jhepr.2021.100264.CrossRefPubMedPubMedCentral

Trebicka J, Bastgen D, Byrtus J, Praktiknjo M, Terstiegen S, Meyer C, et al. Smaller-diameter covered Transjugular Intrahepatic Portosystemic Shunt Stents are Associated with increased survival. Clin Gastroenterol Hepatol. 2019;17(13):2793–9e1. https://doi.org/10.1016/j.cgh.2019.03.042.CrossRefPubMed

Boyer TD, Haskal ZJ. The role of Transjugular Intrahepatic Portosystemic Shunt (Tips) in the management of Portal Hypertension: Update 2009. Hepatology. 2010;51(1).

Boike JR, Thornburg BG, Asrani SK, Fallon MB, Fortune BE, Izzy MJ, et al. North american practice-based recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension. Clin Gastroenterol Hepatol. 2022;20(8):1636–62e36. https://doi.org/10.1016/j.cgh.2021.07.018.CrossRefPubMed

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406–60. https://doi.org/10.1016/j.jhep.2018.03.024.CrossRef

Tripathi D, Stanley AJ, Hayes PC, Travis S, Armstrong MJ, Tsochatzis EA, et al. Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension. Gut. 2020;69(7):1173–92. https://doi.org/10.1136/gutjnl-2019-320221.CrossRefPubMed

García-Pagán JC, Caca K, Bureau C, Laleman W, Appenrodt B, Luca A, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010;362(25):2370–9. https://doi.org/10.1056/NEJMoa0910102.CrossRefPubMed

10.

Hernández-Gea V, Procopet B, Giráldez Á, Amitrano L, Villanueva C, Thabut D, et al. Preemptive‐TIPS improves outcome in high‐risk variceal bleeding: an observational study. Hepatology. 2019;69(1):282–93. https://doi.org/10.1002/hep.30182.CrossRefPubMed

11.

Nicoară-Farcău O, Han G, Rudler M, Angrisani D, Monescillo A, Torres F, et al. 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(1):193–205e10. https://doi.org/10.1053/j.gastro.2020.09.026.CrossRefPubMed

12.

Lv Y, Yang Z, Liu L, Li K, He C, Wang Z, 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(8):587–98. https://doi.org/10.1016/s2468-1253(19)30090-1.CrossRefPubMed

13.

Khan F, Tripathi D. Role of early transjugular intrahepatic portosystemic stent-shunt in acute variceal bleeding: an update of the evidence and future directions. World J Gastroenterol. 2021;27(44):7612–24. https://doi.org/10.3748/wjg.v27.i44.7612.CrossRefPubMedPubMedCentral

14.

••Lv Y, Wang Z, Li K, Wang Q, Bai W, Yuan X et al. Risk Stratification Based on Chronic Liver Failure Consortium Acute Decompensation Score in Patients With Child-Pugh B Cirrhosis and Acute Variceal Bleeding. Hepatology. 2021;73(4):1478-93. doi: 10.1002/hep.31478. There has been a large volume of previous work establishing the uitlity of early TIPS in CP-C patients, and limited utility in CP-A patients. However, CP-B had been less clear. In this work, Lv suggest the utility of using CLIF-C AD scoring to stratify CP-B patients who will benefit most from early TIPS

15.

Trebicka J, Gu W, Ibáñez-Samaniego L, Hernández-Gea V, Pitarch C, Garcia E, et al. Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS. J Hepatol. 2020;73(5):1082–91. https://doi.org/10.1016/j.jhep.2020.04.024.CrossRefPubMed

16.

Thabut D, Pauwels A, Carbonell N, Remy AJ, Nahon P, Causse X, 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. 2017;68(1):73–81. https://doi.org/10.1016/j.jhep.2017.09.002.CrossRefPubMed

17.

Hayes PC, Mookerjee RP. Early TIPS for portal hypertensive related bleeding: is resource or education the reason for failure to show clear survival benefit? J Hepatol. 2018;68(1):8–9. https://doi.org/10.1016/j.jhep.2017.11.001.CrossRef

18.

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(6):1098–107e1. https://doi.org/10.1016/j.cgh.2021.01.027.CrossRefPubMed

19.

Lo GH, Liang HL, Chen WC, Chen MH, Lai KH, Hsu PI, et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy. 2007;39(08):679–85. https://doi.org/10.1055/s-2007-966591.CrossRefPubMed

20.

Procaccini NJ, Al-Osaimi AMS, Northup P, Argo C, Caldwell SH. Endoscopic cyanoacrylate versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding: a single-center U.S. analysis. Gastrointest Endosc. 2009;70(5):881–7. https://doi.org/10.1016/j.gie.2009.03.1169.CrossRefPubMed

21.

Wang YB, Zhang JY, Gong JP, Zhang F, Zhao Y. Balloon-occluded retrograde transvenous obliteration versus transjugular intrahepatic portosystemic shunt for treatment of gastric varices due to portal hypertension: a meta-analysis. J Gastroenterol Hepatol (Australia). 2016;31(4):727–33. https://doi.org/10.1111/jgh.13248.CrossRef

22.

Barange K, Péron J-M, Imani K, Otal P, Payen J-L, Rousseau H, et al. Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices. Hepatology. 1999;30(5):1139–43. https://doi.org/10.1002/hep.510300523.CrossRefPubMed

23.

Rössle M, Ochs A, Gülberg V, Siegerstetter V, Holl J, Deibert P, et al. A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N Engl J Med. 2000;342(23):1701–7. https://doi.org/10.1056/nejm200006083422303.CrossRefPubMed

24.

Salerno F, Merli M, Riggio O, Cazzaniga M, Valeriano V, Pozzi M, et al. Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites. Hepatology. 2004;40(3):629–35. https://doi.org/10.1002/hep.20364.CrossRefPubMed

25.

Sanyal AJ, Genning C, Reddy KR, Wong F, Kowdley KV, Benner K, et al. The north american study for the treatment of Refractory Ascites. Gastroenterology. 2003;124(3):634–41. https://doi.org/10.1053/gast.2003.50088.CrossRefPubMed

26.

Bureau C, Thabut D, Oberti F, Dharancy S, Carbonell N, Bouvier A, et al. Transjugular Intrahepatic Portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites. Gastroenterology. 2017;152(1):157–63. https://doi.org/10.1053/j.gastro.2016.09.016.CrossRefPubMed

27.

Kok B, Abraldes JG. Patient selection in Transjugular Intrahepatic Portosystemic Shunt (TIPS) for refractory Ascites and Associated Conditions. Curr Hepatol Rep. 2019;18(2):197–205. https://doi.org/10.1007/s11901-019-00470-4.CrossRef

28.

Ditah IC, Al Bawardy BF, Saberi B, Ditah C, Kamath PS. Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: a systematic review and cumulative meta-analysis. World J Hepatol. 2015;7(13):1797–806. https://doi.org/10.4254/wjh.v7.i13.1797.CrossRefPubMedPubMedCentral

29.

Romero S, Lim AK, Singh G, Kodikara C, Shingaki-Wells R, Chen L, et al. Natural history and outcomes of patients with liver cirrhosis complicated by hepatic hydrothorax. World J Gastroenterol. 2022;28(35):5175–87. https://doi.org/10.3748/wjg.v28.i35.5175.CrossRefPubMedPubMedCentral

30.

Biggins SW, Angeli P, Garcia-Tsao G, Ginès P, Ling SC, Nadim MK et al. Diagnosis, evaluation, and management of Ascites, spontaneous bacterial peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the study of Liver Diseases. Hepatology. 2021;74(2).

31.

Rössle M, Gerbes AL. TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update. Gut. 2010;59(7):988–1000. https://doi.org/10.1136/gut.2009.193227.CrossRefPubMed

32.

Krishnamoorthy TL, Taneja M, Chang PE. Symptomatic hepatic hydrothorax successfully treated with transjugular intrahepatic portosystemic shunt (TIPS)-role of titration of portosystemic gradient reduction to avoid post-TIPS encephalopathy. Clin Case Rep. 2014;2(3):93–7. https://doi.org/10.1002/ccr3.70.CrossRefPubMedPubMedCentral

33.

Dhanasekaran R, West JK, Gonzales PC, Subramanian R, Parekh S, Spivey JR, et al. Transjugular intrahepatic portosystemic shunt for symptomatic refractory hepatic hydrothorax in patients with cirrhosis. Am J Gastroenterol. 2010;105(3):635–41. https://doi.org/10.1038/ajg.2009.634.CrossRefPubMed

34.

Campos S, Gomes D, Sofia C. Transjugular intrahepatic portosystemic shunt in refractory hydrothorax - a contribution to an unexplored indication. Eur J Gastroenterol Hepatol. 2016;28(6):661–6. https://doi.org/10.1097/meg.0000000000000623.CrossRefPubMed

35.

Young S, Bermudez J, Zhang L, Rostambeigi N, Golzarian J. Transjugular intrahepatic portosystemic shunt (TIPS) placement: a comparison of outcomes between patients with hepatic hydrothorax and patients with refractory ascites. Diagn Interv Imaging. 2019;100(5):303–8. https://doi.org/10.1016/j.diii.2018.10.006.CrossRefPubMed

36.

Gou X, Jia W, He C, Yuan X, Niu J, Xu J, et al. Hepatic hydrothorax does not increase the risk of death after transjugular intrahepatic portosystemic shunt in cirrhosis patients. Eur Radiol. 2023;33(5):3407–15. https://doi.org/10.1007/s00330-022-09357-3.CrossRefPubMed

37.

Rodríguez-Roisin R, Krowka MJ. Hepatopulmonary syndrome–a liver-induced lung vascular disorder. N Engl J Med. 2008;358(22):2378–87. https://doi.org/10.1056/NEJMra0707185.CrossRefPubMed

38.

Allgaier HP, Haag K, Ochs A, Hauenstein KH, Jeserich M, Krause T, et al. Hepato-pulmonary syndrome: successful treatment by transjugular intrahepatic portosystemic stent-shunt (TIPS). J Hepatol. 1995;23(1):102. https://doi.org/10.1016/0168-8278(95)80318-1.CrossRefPubMed

39.

Riegler JL, Lang KA, Johnson SP, Westerman JH. Transjugular intrahepatic portosystemic shunt improves oxygenation in hepatopulmonary syndrome. Gastroenterology. 1995;109(3):978–83. https://doi.org/10.1016/0016-5085(95)90409-3.CrossRefPubMed

40.

Chevallier P, Novelli L, Motamedi J-P, Hastier P, Brunner P, Bruneton J-N. Hepatopulmonary syndrome successfully treated with transjugular intrahepatic portosystemic shunt: a three-year follow-up. J vascular interventional radiology: JVIR. 2004;15(6):647–8. https://doi.org/10.1097/01.rvi.0000127885.68272.e9.CrossRef

41.

Tsauo J, Zhao H, Zhang X, Ma H, Jiang M, Weng N, et al. Effect of Transjugular Intrahepatic Portosystemic Shunt Creation on Pulmonary Gas Exchange in patients with Hepatopulmonary Syndrome: a prospective study. J Vasc Interv Radiol. 2019;30(2):170–7. https://doi.org/10.1016/j.jvir.2018.09.017.CrossRefPubMed

42.

Lasch HM, Fried MW, Zacks SL, Odell P, Johnson MW, Gerber DA, et al. Use of transjugular intrahepatic portosystemic shunt as a bridge to liver transplantation in a patient with severe hepatopulmonary syndrome. Liver Transpl. 2001;7(2):147–9. https://doi.org/10.1053/jlts.2001.21287.CrossRefPubMed

43.

Benítez C, Arrese M, Jorquera J, Godoy I, Conteras A, Loyola S, et al. Successful treatment of severe hepatopulmonary syndrome with a sequential use of TIPS placement and liver transplantation. Ann Hepatol. 2009;8(1):71–4. https://doi.org/10.1016/S1665-2681(19)31816-2.CrossRefPubMed

44.

Simonetto DA, Gines P, Kamath PS. Hepatorenal syndrome: pathophysiology, diagnosis, and management. BMJ. 2020;370:m2687. https://doi.org/10.1136/bmj.m2687.CrossRefPubMed

45.

Guevara M, Ginès P, Bandi JC, Gilabert R, Sort P, Jiménez W, et al. Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: effects on renal function and vasoactive systems. Hepatology. 1998;28(2):416–22. https://doi.org/10.1002/hep.510280219.CrossRefPubMed

46.

Wong F, Pantea L, Sniderman K. Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology. 2004;40(1):55–64. https://doi.org/10.1002/hep.20262.CrossRefPubMed

47.

Brensing KA, Textor J, Perz J, Schiedermaier P, Raab P, Strunk 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(2):288–95. https://doi.org/10.1136/gut.47.2.288.CrossRefPubMedPubMedCentral

48.

Ripoll C, Platzer S, Franken P, Aschenbach R, Wienke A, Schuhmacher U, et al. Liver-HERO: hepatorenal syndrome-acute kidney injury (HRS-AKI) treatment with transjugular intrahepatic portosystemic shunt in patients with cirrhosis-a randomized controlled trial. Trials. 2023;24(1):258. https://doi.org/10.1186/s13063-023-07261-9.CrossRefPubMedPubMedCentral

49.

Inchingolo R, Posa A, Mariappan M, Tibana TK, Nunes TF, Spiliopoulos S, et al. Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: a comprehensive review. World J Gastroenterol. 2020;26(34):5060–73. https://doi.org/10.3748/wjg.v26.i34.5060.CrossRefPubMedPubMedCentral

50.

Garcia-Pagán JC, Heydtmann M, Raffa S, Plessier A, Murad S, Fabris F, et al. TIPS for Budd-Chiari syndrome: long-term results and prognostics factors in 124 patients. Gastroenterology. 2008;135(3):808–15. https://doi.org/10.1053/j.gastro.2008.05.051.CrossRefPubMed

51.

Sonavane AD, Amarapurkar DN, Rathod KR, Punamiya SJ. Long Term Survival of Patients undergoing TIPS in Budd-Chiari Syndrome. J Clin Exp Hepatol. 2019;9(1):56–61. https://doi.org/10.1016/j.jceh.2018.02.008.CrossRefPubMed

52.

Wongjarupong N, Young S, Huynh RK, Lake J, Lim N. Long-term improvement in liver function following Transjugular Intrahepatic Portosystemic Shunt in patients with Budd-Chiari Syndrome. J Clin Exp Hepatol. 2022;12(6):1474–9. https://doi.org/10.1016/j.jceh.2022.07.251.CrossRefPubMedPubMedCentral

53.

Ziser A, Plevak David J, Wiesner Russell H, Rakela J, Offord Kenneth P. Brown David L. Morbidity and Mortality in Cirrhotic Patients undergoing anesthesia and surgery anesthesiology. 1999;90(1):42–53. doi: https://doi.org/10.1097/00000542-199901000-00008.

54.

Chang J, Höfer P, Böhling N, Lingohr P, Manekeller S, Kalff JC, et al. Preoperative TIPS prevents the development of postoperative acute-on-chronic liver failure in patients with high CLIF-C AD score. JHEP Rep. 2022;4(3):100442. https://doi.org/10.1016/j.jhepr.2022.100442. This work explore the hypothesis that TIPS before abdominal surgery might reduce the risk of ACLF, a known complication of abdominal surgery in cirrhotic patients. Chang et al establish a CLIF-AD score>45 as a useful cuttoff for determining who might benefit most from TIPS before a viseral operation to reduce changes of post-operative ACLF.CrossRefPubMedPubMedCentral

55.

Aryan M, McPhail J, Ravi S, Harris P, Allamneni C, Shoreibah M. Perioperative Transjugular Intrahepatic Portosystemic Shunt is Associated with decreased postoperative complications in decompensated cirrhotics undergoing abdominal surgery. Am Surg. 2022;88(7):1613–20. https://doi.org/10.1177/00031348211069784. In this retrospective obervational study, Aryan et al expand the potential benefits of pre-operative TIPS to include lower rates of post-operative ascites, AKI and infection comparted to patients who did not receive pre-operative TIPS.CrossRefPubMed

56.

Manzano-Nunez R, Jimenez-Masip A, Chica-Yanten J, Ibn-Abdelouahab A, Sartelli M, de’Angelis N, et al. Unlocking the potential of TIPS placement as a bridge to elective and emergency surgery in cirrhotic patients: a meta-analysis and future directions for endovascular resuscitation in acute care surgery. World J Emerg Surg. 2023;18(1):30. https://doi.org/10.1186/s13017-023-00498-4.CrossRefPubMedPubMedCentral

57.

Gaba RC, Parvinian A. How quickly does ascites respond to TIPS? Clinical follow-up of a cohort of eighty patients. Diagn Interv Radiol. 2014;20(4):364. https://doi.org/10.5152/dir.2014.13479.CrossRefPubMedPubMedCentral

58.

Busk TM, Bendtsen F, Poulsen JH, Clemmesen JO, Larsen FS, Goetze JP, et al. Transjugular intrahepatic portosystemic shunt: impact on systemic hemodynamics and renal and cardiac function in patients with cirrhosis. Am J Physiol Gastrointest Liver Physiol. 2018;314(2):G275–g86. https://doi.org/10.1152/ajpgi.00094.2017.CrossRefPubMed

59.

Wannhoff A, Hippchen T, Weiss CS, Friedrich K, Rupp C, Neumann-Haefelin C, et al. Cardiac volume overload and pulmonary hypertension in long-term follow-up of patients with a transjugular intrahepatic portosystemic shunt. Aliment Pharmacol Ther. 2016;43(9):955–65. https://doi.org/10.1111/apt.13569.CrossRefPubMed

60.

Rabie RN, Cazzaniga M, Salerno F, Wong F. The use of E/A ratio as a predictor of outcome in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt. Am J Gastroenterol. 2009;104(10):2458–66. https://doi.org/10.1038/ajg.2009.321.CrossRefPubMed

61.

Cazzaniga M, Salerno F, Pagnozzi G, Dionigi E, Visentin S, Cirello I, et al. Diastolic dysfunction is associated with poor survival in patients with cirrhosis with transjugular intrahepatic portosystemic shunt. Gut. 2007;56(6):869–75. https://doi.org/10.1136/gut.2006.102467.CrossRefPubMedPubMedCentral

62.

Jansen C, Schröder A, Schueler R, Lehmann J, Praktiknjo M, Uschner FE, et al. Left ventricular longitudinal Contractility predicts Acute-on-chronic liver failure development and Mortality after Transjugular Intrahepatic Portosystemic Shunt. Hepatol Commun. 2019;3(3):340–7. https://doi.org/10.1002/hep4.1308.CrossRefPubMedPubMedCentral

63.

Mizrahi M, Adar T, Shouval D, Bloom AI, Shibolet O. Endotipsitis-persistent infection of transjugular intrahepatic portosystemic shunt: pathogenesis, clinical features and management. Liver Int. 2010;30(2):175–83. https://doi.org/10.1111/j.1478-3231.2009.02158.x.CrossRefPubMed

64.

Niyas VKM, Keri VC, Kumar P. Endotipsitis: an underdiagnosed complication of Transjugular Intrahepatic Portosystemic shunts. J Clin Exp Hepatol. 2022;12(1):222–4. https://doi.org/10.1016/j.jceh.2021.02.009.CrossRefPubMed

65.

Armstrong PK, MacLeod C. Infection of transjugular intrahepatic portosystemic shunt devices: three cases and a review of the literature. Clin Infect Dis. 2003;36(4):407–12. https://doi.org/10.1086/346156.CrossRefPubMed

66.

Suhocki PV, Lungren MP, Kapoor B, Kim CY. Transjugular intrahepatic portosystemic shunt complications: prevention and management. Semin Intervent Radiol. 2015;32(2):123–32. https://doi.org/10.1055/s-0035-1549376.CrossRefPubMedPubMedCentral

67.

Yang C, Zhu X, Liu J, Shi Q, Du H, Chen Y, et al. Development and Validation of Prognostic Models to Estimate the risk of overt hepatic Encephalopathy after TIPS Creation: a Multicenter Study. Clin Transl Gastroenterol. 2022;13(3):e00461. https://doi.org/10.14309/ctg.0000000000000461.CrossRefPubMedPubMedCentral

68.

Nardelli S, Gioia S, Pasquale C, Pentassuglio I, Farcomeni A, Merli M, et al. Cognitive impairment predicts the occurrence of hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt. Official J Am Coll Gastroenterol | ACG. 2016;111(4):523–8. https://doi.org/10.1038/ajg.2016.29.CrossRef

69.

•• Saab S, Zhao M, Asokan I, Yum JJ, Lee EW. History of Hepatic Encephalopathy Is Not a Contraindication to Transjugular Intrahepatic Portosystemic Shunt Placement for Refractory Ascites. Clin Transl Gastroenterol. 2021;12(8):e00378. doi: 10.14309/ctg.0000000000000378. Refractory ascites is one of the most common indications for TIPS and HE is one of the most common compolications of the procedure. Given that many patients with PH have a history of HE, Saab suggest with this work that HE should not be a contraindication for TIPS as long as the HE is well controlled before TIPS procedure.

70.

Wang Q, Lv Y, Bai M, Wang Z, Liu H, He C, et al. Eight millimetre covered TIPS does not compromise shunt function but reduces hepatic encephalopathy in preventing variceal rebleeding. J Hepatol. 2017;67(3):508–16. https://doi.org/10.1016/j.jhep.2017.05.006.CrossRefPubMed

71.

• Lv Y, Chen H, Luo B, Bai W, Li K, Wang Z et al. Concurrent large spontaneous portosystemic shunt embolization for the prevention of overt hepatic encephalopathy after TIPS: A randomized controlled trial. Hepatology. 2022;76(3):676 – 88. doi: 10.1002/hep.32453. Lv present the first RCT demonstrating the efficacy of concurrent SPSS embolization with TIPS to reduce post-TIPS rates of HE by 62%. This suggests the utility of considering prophylactic large SPSS embolization for specific patients to reduce rates of post-TIPS HE

72.

••Knight GM, Clark J, Boike JR, Maddur H, Ganger DR, Talwar A, et al. 10.1002/hep.31915. Extra hepatic portal vein occlusion from portal vein thrombosis is a disease process with limited treatment options. Here, for the first time, TIPS has been shown as a feasible option for treatment of EHPVO in patients who failed first-line treatments. Hepatology. 2021;74(5):2735–44. TIPS for Adults Without Cirrhosis With Chronic Mesenteric Venous Thrombosis and EHPVO Refractory to Standard-of-Care Therapy.

73.

Thornburg B, Desai K, Hickey R, Hohlastos E, Kulik L, Ganger D, et al. Pretransplantation Portal Vein Recanalization and Transjugular Intrahepatic Portosystemic Shunt Creation for chronic portal vein thrombosis: final analysis of a 61-Patient cohort. J Vasc Interv Radiol. 2017;28(12):1714–21e2. https://doi.org/10.1016/j.jvir.2017.08.005.CrossRefPubMed

74.

Salerno F, Merli M, Cazzaniga M, Valeriano V, Rossi P, Lovaria A, et al. MELD score is better than child-pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol. 2002;36(4):494–500. https://doi.org/10.1016/s0168-8278(01)00309-9.CrossRefPubMed

75.

Krishnan A, Woreta TA, Vaidya D, Liu Y, Hamilton JP, Hong K, et al. MELD or MELD-Na as a predictive model for Mortality following Transjugular Intrahepatic Portosystemic Shunt Placement. J Clin Transl Hepatol. 2023;11(1):38–44. https://doi.org/10.14218/jcth.2021.00513.CrossRefPubMed

76.

Montgomery A, Ferral H, Vasan R, Postoak DW. MELD score as a predictor of early death in patients undergoing Elective Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedures. Cardiovasc Interv Radiol. 2005;28(3):307–12. https://doi.org/10.1007/s00270-004-0145-y.CrossRef

77.

Rashidi-Alavijeh J, Kahraman A, Gerken G, Theysohn JM, Willuweit K, Hoyer DP, et al. Enzymatic liver function measured by LiMAx is superior to current standard methods in predicting transplant-free survival after TIPS implantation. Sci Rep. 2021;11(1):13834. https://doi.org/10.1038/s41598-021-93392-5.CrossRefPubMedPubMedCentral

78.

Cholankeril G, Li AA, Dennis BB, Gadiparthi C, Kim D, Toll AE, et al. Pre-Operative Delta-MELD is an independent predictor of higher mortality following liver transplantation. Sci Rep. 2019;9(1):8312. https://doi.org/10.1038/s41598-019-44814-y.CrossRefPubMedPubMedCentral

79.

Menegaux F, Baker E, Keeffe EB, Monge H, Egawa H, Esquivel CO. Impact of transjugular intrahepatic portosystemic shunt on orthotopic liver transplantation. World J Surg. 1994;18(6):866–70. https://doi.org/10.1007/bf00299089. discussion 70 – 1.CrossRefPubMed

80.

Addeo P, Schaaf C, Faitot F, Terrone A, Julliard O, Besch C, et al. Misplacement of transjugular intrahepatic portosystemic shunts: a surgical challenge for liver transplantation? Surgery. 2021;169(2):447–54. https://doi.org/10.1016/j.surg.2020.07.028.CrossRefPubMed

81.

Hinojosa-Gonzalez DE, Tellez-Garcia E, Salgado-Garza G, Roblesgil-Medrano A, Bueno-Gutierrez LC, Villegas-De Leon SU, et al. Intraoperative and postoperative impact of pretransplantation transjugular intrahepatic portosystemic shunts in orthotopic liver transplantations: a systematic review and meta-analysis. Turk J Surg. 2022;38(2):121–33. https://doi.org/10.47717/turkjsurg.2022.5702.CrossRefPubMedPubMedCentral

82.

Unger LW, Stork T, Bucsics T, Rasoul-Rockenschaub S, Staufer K, Trauner M, et al. The role of TIPS in the management of liver transplant candidates. United Eur Gastroenterol J. 2017;5(8):1100–7. https://doi.org/10.1177/2050640617704807.CrossRef

Titel: TIPS: indications, Contraindications, and Evaluation
verfasst von: Allison Carroll
Justin R. Boike
Publikationsdatum: 21.08.2023
Verlag: Springer US
Erschienen in: Current Gastroenterology Reports / Ausgabe 10/2023
Print ISSN: 1522-8037
Elektronische ISSN: 1534-312X
DOI: https://doi.org/10.1007/s11894-023-00884-7

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Bei Herzinsuffizienz muss „Eisenmangel“ neu definiert werden!

16.05.2024 Herzinsuffizienz Nachrichten

Bei chronischer Herzinsuffizienz macht es einem internationalen Expertenteam zufolge wenig Sinn, die Diagnose „Eisenmangel“ am Serumferritin festzumachen. Das Team schlägt vor, sich lieber an die Transferrinsättigung zu halten.

Herzinfarkt mit 85 – trotzdem noch intensive Lipidsenkung?

16.05.2024 Hypercholesterinämie Nachrichten

Profitieren nach einem akuten Myokardinfarkt auch Betroffene über 80 Jahre noch von einer intensiven Lipidsenkung zur Sekundärprävention? Um diese Frage zu beantworten, wurden jetzt Registerdaten aus Frankreich ausgewertet.

ADHS-Medikation erhöht das kardiovaskuläre Risiko

16.05.2024 Herzinsuffizienz Nachrichten

Erwachsene, die Medikamente gegen das Aufmerksamkeitsdefizit-Hyperaktivitätssyndrom einnehmen, laufen offenbar erhöhte Gefahr, an Herzschwäche zu erkranken oder einen Schlaganfall zu erleiden. Es scheint eine Dosis-Wirkungs-Beziehung zu bestehen.

Erstmanifestation eines Diabetes-Typ-1 bei Kindern: Ein Notfall!

16.05.2024 DDG-Jahrestagung 2024 Kongressbericht

Manifestiert sich ein Typ-1-Diabetes bei Kindern, ist das ein Notfall – ebenso wie eine diabetische Ketoazidose. Die Grundsäulen der Therapie bestehen aus Rehydratation, Insulin und Kaliumgabe. Insulin ist das Medikament der Wahl zur Behandlung der Ketoazidose.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 10/2023

Current Status of Living Donor Liver Transplantation: Impact, Advantages, and Challenges

Immune Checkpoint Inhibitor-Induced (Type 3) Autoimmune Pancreatitis

Nutrition in Liver Disease – A Review

Advances in the Management of Pain in Chronic Pancreatitis

Endoscopic Management of Gallbladder Disease