title: An Algorithm for Management After Transjugular Intrahepatic Portosystemic Shunt Placement According to Clinical Manifestations.
abstract: We propose an algorithm for management after transjugular intrahepatic portosystemic shunt (TIPS) placement according to clinical manifestations. For patients with an initial good clinical response, surveillance Doppler ultrasound is recommended to detect stenosis or occlusion. A TIPS revision can be performed using basic or advanced techniques to treat stenosis or occlusion. In patients with an initial poor clinical response, a TIPS venogram with pressure measurements should be performed to assess shunt patency. The creation of a parallel TIPS may also be required if the patient is symptomatic and the portal pressure remains high after TIPS revision. Additional procedures may also be necessary, such as peritoneovenous shunt (Denver shunt) placement for refractory ascites, tunneled pleural catheter for hepatic hydrothorax, and balloon-occluded retrograde transvenous obliteration procedure for gastric variceal bleeding. A TIPS reduction procedure can also be performed in patients with uncontrolled hepatic encephalopathy or hepatic failure.
authors.affiliation: Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Boulevard, Campus Box 8131, St. Louis, MO, 63110, USA. skim35@wustl.edu.|Department of Radiology, College of Medicine, Kyung Hee University, Seoul, Korea. skim35@wustl.edu.
authors.forename: Seung Kwon
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Boulevard, Campus Box 8131, St. Louis, MO, 63110, USA.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Belikoff
authors.affiliation: Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Boulevard, Campus Box 8131, St. Louis, MO, 63110, USA.
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Guevara
authors.affiliation: Department of Radiology, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Seong Jin
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000465:Algorithms; D001201:Ascites / Q000209:etiology / Q000601:surgery*; D021721:Balloon Occlusion; D001794:Blood Pressure; D019468:Disease Management; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006501:Hepatic Encephalopathy; D006801:Humans; D006876:Hydrothorax / Q000209:etiology / Q000601:surgery*; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery*; D010536:Peritoneovenous Shunt; D010690:Phlebography; D017082:Portal Pressure; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012086:Reoperation; D018608:Ultrasonography, Doppler
keywords: Balloon occlusion; Gastric varices; Portal hypertension; Portosystemic shunt