Hepatic Veins ; physiopathology ; Humans ; Hypertension, Portal ; physiopathology ; Portal Pressure

Arteriovenous Fistula ; Humans ; Hypertension, Portal

The performance of transjugular intrahepatic portosystemic shunt (TIPS) has two key procedures: (1) portal vein branch puncturing, and (2) the correct judgment of the safety of the puncture site. The portal vein branch puncturing is the most important and difficult step for a successful TIPS procedure. Therefore, to find and to establish an proper access to the portal vein is critical. Nowadays, in clinical practice several imaging techniques have been used to localize the portal vein, such as magnetic resonance imaging, sonography, fluoroscopy, arteriography and computed tomography. This article aims to make a general review on these invasive and non - invasive localization techniques when a successful performance of TIPS is expected.

Liver failure is a clinical syndrome with severe disorders of liver cells for biosynthesis, detoxication, excretion, and biological transformation, which presents with coagulation disorders, jaundice, hepatic encephalopathy, and ascites. Liver failure progresses rapidly, so the prediction of clinical outcome is significant for the diagnosis and treatment. In recent years, there have been numerous reports on the prediction of clinical outcome in patients with liver failure. The study and application of serological and comprehensive models are reviewed, which provides a reference for the rational therapy for liver failure patients.

ObjectiveTo analyze the efficacy of endoscopic histoacryl injection in the treatment of gastric variceal bleeding caused by regional portal hypertension. MethodsThe endoscopic features and efficacy of endoscopic histoacryl injection were examined and compared in two groups of patients admitted to our hospital from June 2012 to December 2012. One of the groups included 6 patients with gastric variceal bleeding caused by regional portal hypertension and the other group included 6 patients with gastric variceal bleeding caused by hepatitis B cirrhosis-related portal hypertension. Between-group comparison of categorical data was made by Fisher′s test. ResultsIn patients with regional portal hypertension, five of them had severe isolated gastric varices (IGV) and one had severe IGV with mild esophageal varices. All six patients with hepatitis B cirrhosis-related portal hypertension had severe IGV and the endoscopic features were similar to those of patients with regional portal hypertension. Significant differences were observed between the group with regional portal hypertension and the group with hepatitis B cirrhosis related portal hypertension in short-term response rate (1/6 vs 6/6, P=0.015) and long-term response rate (0/6 vs 5/6, P=0.015). ConclusionThe gastric varices caused by regional portal hypertension has a fast progression rate and a high bleeding risk. The efficacy of endoscopic histoacryl injection in patients with this type of gastric varices is poor.

Chronic hepatitis B (CHB) is one of the most important infectious diseases around the world. Currently, interferon and nucleos(t)ide analogues are the main drugs for CHB and have good therapeutic efficacy, but the ultimate goal of eliminating hepatitis B virus (HBV) in human body has not been achieved. Therefore, it is of vital importance to explore new therapeutic strategies and develop new drugs for CHB. Persistent HBV infection is closely associated with human body′s immune status, and studies have shown that immunotherapy may help to cure CHB. With reference to CHB patients′ immune status, this article reviews the research advances in new immunotherapeutic strategies including Toll-like receptor agonists, cell therapy, and therapeutic vaccines.

Portal hypertension is a common clinical disease and brings a series of complications including the formation of gastrointestinal varicose veins, ascites, hepatic encephalopathy, and abdominal varicose veins. Most of these complications are related to the opening of collateral circulation after the increase in portal venous pressure. On one hand, collateral circulation helps to alleviate the high portal venous pressure, and on the other hand, it brings related complications to patients. This article reviews recent reports and studies on collateral circulation related to portal hypertension, in order to increase our knowledge of collateral circulation in portal hypertension and improve clinical diagnosis and treatment of such disease.

There are not many studies on chronic hepatitis C complicated by autoimmune hepatitis, and up to now, the clinical diagnosis and treatment of such diseases still face many difficulties. Although related articles put forward some recommendations, there are no standard guidelines for diagnosis and treatment, and clinical physicians need to provide treatment for these patients based on their personal experience. This article summarizes related articles on chronic hepatitis C complicated by autoimmune hepatitis in order to provide help to clinical physicians when they face similar clinical problems in the future.

ObjectiveTo investigate the causes of dysfunction of COOK bare stent, Wallgraft covered stent, and Fluency covered stent after transjugular intrahepatic portosystemic shunt (TIPS) and related countermeasures. MethodsThe clinical data of 54 patients who were found to have stent dysfunction and underwent TIPS correction in our hospital from January 2011 to July 2017 were collected. Balloon dilatation, coaxial stent implantation, or parallel TIPS was selected based on angiography results and portal venous pressure to repair stent dysfunction. The Kruskal-Wallis H test was used to compare in-stent restenosis or occlusion time between the three types of stents, and the paired t-test was used to compare portal vein perfusion (PVP) before and after correction. Radiological examination was performed to evaluate stent dysfunction, and the cause of in-stent restenosis or occlusion was analyzed. ResultsTIPS correction was successfully performed for all 54 patients. Stenosis was observed in the hepatic vein, the liver parenchyma, or the portal vein, and there was a high incidence rate within 6-24 months after surgery. The median time to stenosis or occlusion was 17.0 months for COOK bare stent, 10.0 months for Wallgraft covered stent, and 17.0 months for Fluency covered stent. COOK bare stent and Fluency covered stent had a longer time to stenosis or occlusion than Wallgraft covered stent (P=0.013 and 0.023), and there was no significant difference in the time to stenosis or occlusion between COOK bare stent and Fluency covered stent (P=0.893). As for the surgical procedure of TIPS correction, 4 patients underwent balloon dilatation, 39 underwent coaxial stent implantation, and 11 underwent parallel TIPS. There was a significant reduction in portal venous pressure after surgery (25.6±4.8 cm H2O vs 34.7±6.4 cm H2O, P＜0.001). ConclusionWallgraft stent has a significantly shorter time to stent dysfunction after TIPS than COOK bare stent and Fluency covered stent, suggesting that Wallgraft stent is not suitable for the initial establishment of TIPS shunt. Correction procedures should be selected based on actual conditions to repair stent dysfunction and restore shunt patency.

Patients with decompensated cirrhosis often have varying degrees of portal hypertension, and when portal pressure reaches a certain threshold, various clinical complications may occur and even threaten patients′ lives. Therefore, portal pressure assessment is important for the clinical management and prognosis of such patients. Due to the anatomical characteristics of the portal vein, it is difficult to measure portal pressure directly. At present, hepatic venous pressure gradient is used to replace portal pressure in China and foreign countries. However, the measurement of hepatic venous pressure gradient is an interventional procedure and is difficult to perform in clinical practice. Therefore, noninvasive assessment of portal hypertension has become a research hotspot. This article reviews the research advances in the roles of serum markers, ultrasound elastography, computed tomography, and magnetic resonance imaging/magnetic resonance elastography in noninvasive assessment of portal hypertension.