Humans ; Portasystemic Shunt, Transjugular Intrahepatic ; standards

Contraindications ; Humans ; Portasystemic Shunt, Transjugular Intrahepatic

No abstract available.
Female ; Humans ; Hypertension, Portal/*diagnosis ; Male ; *Portasystemic Shunt, Transjugular Intrahepatic

Contraindications ; Humans ; Portasystemic Shunt, Transjugular Intrahepatic ; adverse effects

Humans ; Liver Cirrhosis ; therapy ; Portasystemic Shunt, Transjugular Intrahepatic

Ascites ; etiology ; therapy ; Diuretics ; therapeutic use ; Humans ; Hypertension, Portal ; complications ; Peritoneovenous Shunt ; Portasystemic Shunt, Transjugular Intrahepatic

Transjugular intrahepatic portasystemic shunt (TIPS) is a procedure that inserts an expandable metallic stent into the liver parenchyme by transjugular catheterization. During the past decade, TIPS has been accepted as an alternative to the surgical shunt procedure for controlling the complications of portal hypertension and has become more widely performed. Complications of TIPS include encephalopathy, bleeding, deterioration of liver function and infection. Although periprocedual sepsis has been known since the early days of TIPS stenting, infection by the TIPS device itself has only recently been recognized because of its rare occurrence. The definition of endotipsitis makes it possible to classify it into two groups: definite and probable infection. We report a case of probable endotipsitis with relapsing bacteremia after TIPS for uncontrolled varix bleeding. If relapsing bacteremia without any other clearly attributable source occurs in a patient with TIPS, the possibility of endotipsitis is considered.
Bacteremia ; Catheterization ; Catheters ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver ; Portasystemic Shunt, Surgical ; Portasystemic Shunt, Transjugular Intrahepatic* ; Sepsis ; Stents ; Varicose Veins

Transjugular intrahepatic portosystemic shunts (TIPS) are widely used in the management of bleeding gastric varices (GV). More recently, several studies have demonstrated balloon-occluded retrograde transvenous obliteration (BRTO) as an effective treatment method for bleeding isolated GV, especially in patients with contraindications for a TIPS placement. Both TIPS and BRTO can effectively treat bleeding GV with low rebleeding rates. Careful patient selection for TIPS and BRTO procedures is required to best treat the patient's individual clinical situation.
Balloon Occlusion ; Embolization, Therapeutic ; Esophageal and Gastric Varices* ; Hemorrhage ; Humans ; Methods ; Patient Selection ; Portasystemic Shunt, Surgical* ; Portasystemic Shunt, Transjugular Intrahepatic

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*

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.