Therapy of portal hypertension using transjugular intrahepatic portosystemic shunt – first 1,000 procedures in UH Hradec Kralove

Česká verzia

Authors: A. Krajina ¹; P. Hůlek ^2,3; Miroslav Lojík ¹ ; V. Chovanec ¹; O. Renc ¹; J. Raupach ¹; T. Fejfar ²; V. Jirkovský ²; V. Šafka ⁴; Š. Šembera ²; T. Vaňásek ²
Authors place of work: Radiologická klinika LF UK a FN Hradec Králové ¹; II. interní gastroenterologická klinika LF UK a FN Hradec Králové ²; Interní klinika LF OU, Ostrava ³; Ústav fyziologie, LF UK, Hradec Králové ⁴
Published in the journal: Gastroent Hepatol 2014; 68(2): 100-107
Category: Hepatology: Review article

Summary

Transjugular intrahepatic portosystemic shunt (TIPS) has been available for clinical practice since 1989, and in the Czech Republic since 1992. It is mostly used in patients suffering from liver cirrhosis and related complications such as GI bleeding or large ascites. In fact it is a side-to-side portacaval anastomosis reinforced with a metal stent and created by interventional radiologist without surgery. In the course of the 25 years of its clinical use, some changes have occurred: more than one-third of patients suffer from hepatic encephalopathy, but treatment with rifaximin is successful in most of them. The bare stent used for TIPS in the initial period, having a much higher risk of patency problems, was replaced by a covered stent (stent-graft). Though many indications were specified, some others still await confirmation, e.g. indication of TIPS according to the portacaval gradient. In the latest period, the number of indications for GI bleeding is decreasing, but the number of procedures for ascites and hydrothorax, having more altered liver functions, is rising. TIPS reduces portal pressure but does not improve liver function, so it cannot substitute liver transplantation. TIPS is performed by an interventional radiologist, but cooperation with the hepatologist is a fundamental condition for good treatment of patients. For the time of its existence, TIPS has established a firm position in the therapeutic portfolio of portal hypertension complications.

Key words:
liver cirrhosis – portal hypertension – transjugular intrahepatic – portosystemic shunt

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
24. 2. 2014

Accepted:
17. 3. 2014

Zdroje

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