No abstract available.
Portasystemic Shunt, Surgical

No abstract available.
Hepatolenticular Degeneration* ; Portasystemic Shunt, Surgical*

No abstract available.
Hepatitis Viruses* ; Hepatitis* ; Humans ; Portasystemic Shunt, Surgical*

Portal vein access has historically been the most technically challenging step in the creation of transjugular intrahepatic portosystemic shunts (TIPSs). The use of intravascular ultrasound (IVUS) for guidance of portal vein access during TIPS creation has garnered much interest in recent years. Recent literature has suggested potential improvements in procedural metrics that may result from use of IVUS for TIPS. This review aims to provide historical context, detail technical advances and describe recent clinical experience with the use of IVUS for TIPS creation.
Portal Vein ; Portasystemic Shunt, Surgical ; Ultrasonography

Embolization, Therapeutic ; Humans ; Hypertension, Portal ; therapy ; Portasystemic Shunt, Surgical

PURPOSE: To evaluate the efficiency of variceal embolization using a stainless steel coil during TIPS forrecurrent variceal bleeding. MATERIALS AND METHODS: In 53 of a total of 141 patients who underwent TIPS forgastric or esophageal variceal bleeding between August 1991 and Jan 1998 we performed variceal embolization usinga stainless steel coil during the procedure. To compare embolized and non-embolized cases the cumulativerebleeding rate was calculated by the Kaplan-Meier method and statistical significance was analyzed using theLog-rank test. RESULTS: Of the 33 patients who suffered recurrent variceal bleeding, 14 had undergone varicealembolization and 19 had not. One-year, two-year and three-year rebleeding rate in embolized and non-embolizedcases were 23%/12%, 31%/25%, and 53.7%/42%, respectively. Cumulative rebleeding rates are highest within two yearsin embolized cases and highest after two years in non-embolized cases, however there is no statisticalsignificance between the two groups(p>0.05). CONCLUSION: Variceal embolization with stainless steel coil duringTIPS does not effectively prevent recurrent variceal bleeding.
Esophageal and Gastric Varices ; Humans ; Portasystemic Shunt, Surgical* ; Stainless Steel

This study aimed to report three new cases of an association between two rare conditions, congenital portosystemic shunts (CPSS) and trimethylaminuria (TMAU), and the efficacy of endovascular closure of the CPSS for resolving TMAU. Between November 2014 and April 2017, 15 patients with CPSS were enrolled in this prospective study to assess the efficacy of percutaneous endovascular shunt closure. Three patients presented with clinical symptoms of TMAU that were confirmed by urine analysis of trimethylamine (TMA) and TMA n-oxide. One year after endovascular closure of the congenital portosystemic shunt, the same parameters were evaluated were obtained and the values were compared to the pretreatment values. The results indicated the disappearance of clinical symptoms of TMAU and normalization of the urine test parameters in two patients and no changes in one patient, who developed new portosystemic communications.
Humans ; Portasystemic Shunt, Surgical ; Prospective Studies ; Radiology, Interventional

Summary of Event: A transjugular intrahepatic portosystemic shunt (TIPS) stent (Viatorr) was misplaced into main portal vein and superior mesenteric vein. This misplaced covered stent was then successfully retrieved using the rigid endobronchial forceps. Teaching Point: Before release the covered portion of the TIPS stent (Viatorr), it is necessary to confirm the position of uncovered portion in portal vein and covered portion in parenchymal tract. The endobronchial forceps technique is a safe and efficient method for retrieving a misplaced TIPS stent.
Device Removal ; Mesenteric Veins ; Methods ; Portal Vein ; Portasystemic Shunt, Surgical* ; Portasystemic Shunt, Transjugular Intrahepatic ; Stents* ; Surgical Instruments*

Intervention treatment such as balloon retrograde or anterograde transvenous obliteration has been used for management of refractory hepatic encephalopathy as well as gastric variceal bleeding. Recently, plug-assisted retrograde transvenous obliteration without a help of balloon was newly developed to treat these patients. Here, we report three cases suffering refractory hepatic encephalopathy who were treated with this new technique.
Balloon Occlusion ; Esophageal and Gastric Varices ; Hepatic Encephalopathy* ; Humans ; Portasystemic Shunt, Surgical ; Splenorenal Shunt, Surgical*

BACKGROUNDThe purpose of this article was to clarify the optimal management concerning transjugular intrahepatic portosystemic shunts (TIPSs) and surgical shunting in treating portal hypertension.

METHODSAll databases, including CBM, CNKI, WFPD, Medline, EMBASE, PubMed and Cochrane up to February 2014, were searched for randomized controlled trials (RCTs) comparing TIPS with surgical shunting. Four RCTs, which were extracted by two independent investigators and were evaluated in postoperative complications, mortality, 2- and 5-year survival, hospital stay, operating time and hospitalization charges.

RESULTSThe morbidity in variceal rehemorrhage was significantly higher in TIPS than in surgical shunts (odds ratio [OR] = 7.45, 95% confidence interval[CI]: (3.93-14.15), P < 0.00001), the same outcomes were seen in shunt stenosis (OR = 20.01, 95% CI: (6.67-59.99), P < 0.000001) and in hepatic encephalopathy (OR = 2.50, 95% CI: (1.63-3.84), P < 0.0001). Significantly better 2-year survival (OR = 0.66; 95% CI: (0.44-0.98), P = 0.04) and 5-year survival (OR = 0.44; 95% CI: (0.30-0.66), P < 0.00001) were seen in patients undergoing surgical shunting compared with TIPS.

CONCLUSIONSCompared with TIPS, postoperative complications and survival after surgical shunting were superior for patients with portal hypertension. Application of surgical shunting was recommended for patients rather than TIPS.