Tags

Type your tag names separated by a space and hit enter

Transjugular intrahepatic portosystemic shunt as a form of treatment for portal hypertension: indications and contraindications.
Adv Intern Med. 1997; 42:485-504.AI

Abstract

The TIPS clearly has had a major impact on the treatment of complications of portal hypertension in the cirrhotic patient. Currently, TIPS is performed in community hospitals as well as university centers in the United States. While the shunt is placed under local anesthesia in a nonoperative fashion, it must be remembered that it does function as a highly effective side-to-side shunt with its attendant complications including hepatic encephalopathy and occasional liver failure. Early reports of clinical and hemodynamic results after TIPS have clearly demonstrated it to be an effective bridge to liver transplantation. Nonetheless, transplantation candidates who experience their initial episode of variceal hemorrhage still should be managed with sclerotherapy or variceal band ligation. However, if bleeding recurs during a course of treatment or cannot be acutely controlled, TIPS has proved invaluable in stabilizing patients prior to liver transplantation. Refractory variceal bleeding in Child's class C patients, in whom the perioperative mortality associated with surgical shunts is high, is also reasonable indication for TIPS. Potential, but less well-proved indications for TIPS include refractory ascites, hepatic hydrothorax, and the Budd-Chiari syndrome. Refractory variceal hemorrhage in Child's class A or B patients, bleeding from portal hypertensive gastropathy, and HRS represent possible, but unproved, indications. Preoperative reduction in portal hypertension prior to liver transplantation does not appear to represent an appropriate indication for TIPS. In spite of the wide acceptance of TIPS, it will be important to continue to study its indications and its complications so that it can be optimally used in the treatment of patients with portal hypertension.

Authors+Show Affiliations

Department of Medicine, University of California, San Francisco, School of Medicine, USA.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

9048128

Citation

Brown, R S., and J R. Lake. "Transjugular Intrahepatic Portosystemic Shunt as a Form of Treatment for Portal Hypertension: Indications and Contraindications." Advances in Internal Medicine, vol. 42, 1997, pp. 485-504.
Brown RS, Lake JR. Transjugular intrahepatic portosystemic shunt as a form of treatment for portal hypertension: indications and contraindications. Adv Intern Med. 1997;42:485-504.
Brown, R. S., & Lake, J. R. (1997). Transjugular intrahepatic portosystemic shunt as a form of treatment for portal hypertension: indications and contraindications. Advances in Internal Medicine, 42, 485-504.
Brown RS, Lake JR. Transjugular Intrahepatic Portosystemic Shunt as a Form of Treatment for Portal Hypertension: Indications and Contraindications. Adv Intern Med. 1997;42:485-504. PubMed PMID: 9048128.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transjugular intrahepatic portosystemic shunt as a form of treatment for portal hypertension: indications and contraindications. AU - Brown,R S,Jr AU - Lake,J R, PY - 1997/1/1/pubmed PY - 2001/3/28/medline PY - 1997/1/1/entrez SP - 485 EP - 504 JF - Advances in internal medicine JO - Adv Intern Med VL - 42 N2 - The TIPS clearly has had a major impact on the treatment of complications of portal hypertension in the cirrhotic patient. Currently, TIPS is performed in community hospitals as well as university centers in the United States. While the shunt is placed under local anesthesia in a nonoperative fashion, it must be remembered that it does function as a highly effective side-to-side shunt with its attendant complications including hepatic encephalopathy and occasional liver failure. Early reports of clinical and hemodynamic results after TIPS have clearly demonstrated it to be an effective bridge to liver transplantation. Nonetheless, transplantation candidates who experience their initial episode of variceal hemorrhage still should be managed with sclerotherapy or variceal band ligation. However, if bleeding recurs during a course of treatment or cannot be acutely controlled, TIPS has proved invaluable in stabilizing patients prior to liver transplantation. Refractory variceal bleeding in Child's class C patients, in whom the perioperative mortality associated with surgical shunts is high, is also reasonable indication for TIPS. Potential, but less well-proved indications for TIPS include refractory ascites, hepatic hydrothorax, and the Budd-Chiari syndrome. Refractory variceal hemorrhage in Child's class A or B patients, bleeding from portal hypertensive gastropathy, and HRS represent possible, but unproved, indications. Preoperative reduction in portal hypertension prior to liver transplantation does not appear to represent an appropriate indication for TIPS. In spite of the wide acceptance of TIPS, it will be important to continue to study its indications and its complications so that it can be optimally used in the treatment of patients with portal hypertension. SN - 0065-2822 UR - https://www.unboundmedicine.com/medline/citation/9048128/Transjugular_intrahepatic_portosystemic_shunt_as_a_form_of_treatment_for_portal_hypertension:_indications_and_contraindications_ L2 - http://www.diseaseinfosearch.org/result/5881 DB - PRIME DP - Unbound Medicine ER -