Transjugular intrahepatic portosystemic shunts: An update

被引:47
作者
Rosado, B [1 ]
Kamath, PS [1 ]
机构
[1] Mayo Clin & Mayo Fdn, Div Gastroenterol & Hepatol, Rochester, MN 55905 USA
关键词
D O I
10.1053/jlts.2003.50045
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Transjugular intrahepatic portosystemic shunts (TIPS) have been used in the treatment of complications of portal hypertension. TIPS is used for the control of acute variceal bleeding and for the prevention of vericeal rebleeding when pharmacologic therapy and endoscopic therapy have failed. Patients with refractory ascites with adequate hepatic reserve and renal function who fail to respond to large volume paracentesis may be reasonable candidates for TIPS. Promising indications for TIPS are Budd-Chiari syndrome uncontrolled by medical therapy, severe portal hypertensive gastropathy, refractory hepatic hydrothorax, and hepatorenal syndrome. TIPS cannot be recommended for preoperative portal decompression solely to facilitate liver transplantation. Special care should be taken to insure proper placement of the stent to avoid increasing the technical difficulty of the transplantation procedure. The major limiting factors for TIPS success are shunt dysfunction and hepatic encephalopathy. Because shunt stenosis is the most important cause of recurrent complications of portal hypertension, a surveillance program to monitor shunt patency is mandatory. The MELD score may be useful in predicting post-TIPS survival, and also in counseling patients and their families.
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页码:207 / 217
页数:11
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共 70 条
[1]   Reversal of type 1 hepatorenal syndrome with the administration of midodrine and octreotide [J].
Angeli, P ;
Volpin, R ;
Gerunda, G ;
Craighero, R ;
Rone, P ;
Merenda, R ;
Amodio, P ;
Sticca, A ;
Caregaro, L ;
Maffei-Faccioli, A ;
Gatta, A .
HEPATOLOGY, 1999, 29 (06) :1690-1697
[2]  
[Anonymous], HEPATOLOGY
[3]   Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis [J].
Arroyo, V ;
Gines, P ;
Gerbes, AL ;
Dudley, FJ ;
Gentilini, P ;
Laffi, G ;
Reynolds, TB ;
RingLarsen, H ;
Scholmerich, J .
HEPATOLOGY, 1996, 23 (01) :164-176
[4]   Salvage transjugular intrahepatic portosystemic shunt for uncontrolled variceal bleeding in patients with decompensated cirrhosis [J].
Azoulay, D ;
Castaing, D ;
Majno, P ;
Saliba, F ;
Ichaï, P ;
Smail, A ;
Delvart, V ;
Danaoui, M ;
Samuel, D ;
Bismuth, H .
JOURNAL OF HEPATOLOGY, 2001, 35 (05) :590-597
[5]   Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices [J].
Barange, K ;
Péron, JM ;
Imani, K ;
Otal, P ;
Payen, JL ;
Rousseau, H ;
Pascal, JP ;
Joffre, F ;
Vinel, JP .
HEPATOLOGY, 1999, 30 (05) :1139-1143
[6]   BUDD-CHIARI SYNDROME - TECHNICAL, HEMODYNAMIC, AND CLINICAL-RESULTS OF TREATMENT WITH TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT [J].
BLUM, U ;
ROSSLE, M ;
HAAG, K ;
OCHS, A ;
BLUM, HE ;
HAUENSTEIN, KH ;
ASTINET, F ;
LANGER, M .
RADIOLOGY, 1995, 197 (03) :805-811
[7]   Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study [J].
Brensing, KA ;
Textor, J ;
Perz, J ;
Schiedermaier, P ;
Raab, P ;
Strunk, H ;
Klehr, HU ;
Kramer, HJ ;
Spengler, U ;
Schild, H ;
Sauerbruch, T .
GUT, 2000, 47 (02) :288-295
[8]   Transjugular intrahepatic portosystemic shunt versus sclerotherapy in the elective treatment of variceal hemorrhage [J].
Cabrera, J ;
Maynar, M ;
Granados, R ;
Gorriz, E ;
Reyes, R ;
PulidoDuque, JM ;
SanRoman, JLR ;
Guerra, C ;
Kravetz, D .
GASTROENTEROLOGY, 1996, 110 (03) :832-839
[9]   Clinical events after transjugular intrahepatic portosystemic shunt:: Correlation with hemodynamic findings [J].
Casado, M ;
Bosch, J ;
García-Pagán, JC ;
Bru, C ;
Bañares, R ;
Bandi, JC ;
Escorsell, A ;
Rodríguez-Láiz, JM ;
Gilabert, R ;
Feu, F ;
Schorlemer, C ;
Echenagusia, A ;
Rodés, J .
GASTROENTEROLOGY, 1998, 114 (06) :1296-1303
[10]   Is transjugular intrahepatic portosystemic shunt really deleterious for liver transplantation issue? A monocentric study on 86 liver transplanted patients [J].
Castellani, P ;
Campan, P ;
Bernardini, D ;
Moulin, G ;
Bartoli, JM ;
Le Treut, YP ;
Gauthier, A ;
Botta-Fridlund, D .
TRANSPLANTATION PROCEEDINGS, 2001, 33 (7-8) :3468-3469