Interventional treatment of portal hypertension.
For many years now, percutaneous transhepatic and transjugular approaches to the portal vein have been applied by gastroenterologists and radiologists for diagnosis and therapy. In patients with variceal bleeding these techniques were used to obliterate the varices, and have provided the knowledge for further developments, such as the creation of an intrahepatic portosystemic shunt by balloon dilatation of the needle tract between the portal vein and a hepatic vein. The recent development of expandable vascular stents has led to improvements in the efficiency and long-term patency of interventional shunts, and justified their clinical application. The rationales for this new approach to the treatment of portal hypertension are its relative safety, even in Child C patients, and the disabilities such as rebleeding or aggravation of hepatic encephalopathy of other current treatments. Since the first clinical application of the transjugular intrahepatic portosystemic stent-shunt in January 1988, the technique has been improved considerably, and the frequency of its application is increasing rapidly. This article attempts to summarize the current state of knowledge of this interventional technique, which will soon have its place among the various methods of treating portal hypertension.
Rössle
M
M
Medizinische Universitätsklinik, Freiburg, FRG.
Haag
K
K
D000075202:Contraindications; D004932:Esophageal and Gastric Varices / Q000601:surgery; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology / Q000601:surgery*; D010865:Pilot Projects; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects; D012008:Recurrence