Author/Editor     Lake, John R
Title     Transjugular intrahepatic portosystemic stent shunts (TIPS)
Type     članek
Source     In: Hepatobiliary school. Book of lectures and abstracts of the 6th postgraduate course in hepatology - postgraduate course in HPB surgery; 1998 Jun 20-24; Ljubljana. Ljubljana: University medical center,
Publication year     1998
Volume     str. 117-31
Language     eng
Abstract     The transjugular intrahepatic portosystemics hunt clearly has had a major impact on the treatment of complications of portal hypertension in the cirrhotic patient. While the shunt is placed under local anesthesia in a non-operative fashion, it must be remembered that it does function as highly effective side-to-side shunt with its attendant complications ubcluding hepatic encephalopathy and occasional liver failure. Early ports of clinical and hemodynamic results after TIPS have clearly demonstrated it to be an effective bridge to liver transplantation. None the less, transplant candidates who experience their initial episode of variceal hemorrhage still should be managed with sclerotherapy of variceal band ligation. However, if bleeding recurs during a course of treatment or cannot be acutely controlled, TIPS has proved in valuable in stabilizing patients prior to liver transplantation. Refractory varieceal bleeding in Child's Class C patients, in whom the peri-operative mortality associated with surgical shunt is high, is also a reasonable indication for TIPS. Potential, but less well-proven 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 hypertnesive gastropathy and hepatorenal syndrome represent possible, but unproven, indications. 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 utilized in the treatment of patients with portal hypertension.
Descriptors     PORTASYSTEMIC SHUNT, TRANSJUGULAR INTRAHEPATIC
HEPATIC ENCEPHALOPATHY
CHICKENPOX
HEPATIC VEIN THROMBOSIS
ASCITES
HEPATORENAL SYNDROME
HYDROTHORAX
THROMBOEMBOLISM
LIVER FAILURE