| Author/Editor | Popovič, Peter | |
| Title | Vloga in mesto transjugularnega portosistemskega odvoda (TIPS) v vodenju portalne hipertenzije | |
| Type | monografija | |
| Place | Ljubljana | |
| Publisher | Univerza v Ljubljani, Medicinska fakulteta | |
| Publication year | 2005 | |
| Volume | str. 56 | |
| Language | slo | |
| Abstract | In ther introductory part, the author describes the aetiology, course and complications of portal hypertension (PH). Bleeding from oesophageal and gastric varices is the most common lifethreatening complication of elevated portal pressure. The first rebleeding episode and frequent recurrent bleedings are associated with high mortality rates. The author describes primary prevention of first rebleeding, treatment of acute haemorrhage and secondary prevention of recurrent bleeding episodes. Acute and recurrent oesophagogastric variceal bleedings are controlled by reducing portal venous pressure using beta blockers, portacaval shunting, placement of transjugular intrahepatic portal systemic shunt (TIPS) and endoscopic interruption of blood flow through varices by sclerotherapy (EST) and varix ligation. Surgical procedures and TIPS placement are indicated only in patients with haemorrhage refractory to pharmacologic and endoscopic control or stabilisation. The paper gives a detailed description of TIPS placement and analyses the complications associated with elective TIPS. The efficiency of TIPS in preventing variceal rebleeding is compared with that of endoscopic sclerotherapy used in combination with beta blockers. Of the 96 patients with hepatic cirrhosis and PH (portal hypertension) included in the study, 50 were treated with TIPS and 4b with EST. The latter were found to have a significantly higher incidence of haemorrhage than the TIPS group (46% - 21 patients vs. 6% - 3 patients). Shunt occlusion is the most frequent cause of variceal rebleeding following TIPS. Timely identification of this complication and prompt intervention have improved the rate of primary assisted patency at 4 years (87.3 %). Statistically significantly increased mortality after EST was confirmed. Multivariate analysis revealed significantly improved 30-day and 5-year survival rates following TIPS placement. (Abstract truncated at 2000 characters) | |
| Descriptors | HYPERTENSION, PORTAL ESOPHAGEAL AND GASTRIC VARICES GASTROINTESTINAL HEMORRHAGE SCLEROTHERAPY PORTASYSTEMIC SHUNT, TRANSJUGULAR INTRAHEPATIC LIVER CIRRHOSIS TREATMENT OUTCOME SURVIVAL ANALYSIS |