Transjugular intrahepatic portosystemic shunt for acute variceal hemorrhage.
Acute variceal hemorrhage is life-threatening and requires a multidisciplinary approach for effective therapy. Transfusion of blood products, systemic therapy with vasopressin, octreotide, and selective beta-blockers and early endoscopic therapy are often effective; however, uncontrollable variceal hemorrhage is best treated with transjugular intrahepatic porto-systemic shunt (TIPS) creation. This procedure involves establishment of a direct pathway between the hepatic veins and the portal veins to decompress the portal venous hypertension that is the source of the patient's hemorrhage. The procedure is technically challenging, especially in critically ill patients, and has a mortality of 30%-50% in the emergency setting, but has greater than 90% effectiveness in controlling bleeding from gastroesophageal varices. In this review, we discuss the technical aspects of TIPS and briefly examine the results of TIPS in managing acute variceal hemorrhage.
Harvard Medical School, Section of Cardiovascular Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. skalva@partners.org
Sanjeeva P
SP
Kalva
Gloria M
GM
Salazar
T Gregory
TG
Walker
D000208:Acute Disease; D004621:Embolization, Therapeutic; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000401:mortality / Q000601:surgery; D010690:Phlebography; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D011172:Portography; D015641:Radiography, Interventional; D015607:Stents; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014690:Venous Pressure