How is TIPS patency followed? TIPS patency can be followed noninvasively by color Doppler ultrasound or venography. Protocols differ among institutions. Two-year primary patency rates with the use of the Viatorr stent graft are 76% to 84%, and thus the need for frequent routine ultrasound surveillance is in question. If an early ultrasound evaluation is …
Which liver disease scoring system, CP or Model for End-Stage Liver Disease (MELD), more effectively predicts survival after TIPS creation? MELD score is superior to CP score at predicting post-TIPS mortality. A MELD score of more than 18 predicts a significant higher 30-day and 90-day mortality after TIPS compared with patients with a MELD score …
Effective liver disease scoring system to predict survival after TIPS creation Read More »
What should the portosystemic pressure gradient (PSG) be reduced to for TIPS placed for variceal bleeding as opposed to TIPS placed for refractory ascites? The post-TIPS PSG should be reduced to less than 12 mm Hg to prevent rebleeding episodes. The degree of PSG reduction to control ascites is unclear but a PSG of 12 …
What should the PSG be reduced to for TIPS for variceal bleeding Read More »
Contraindications to performing the TIPS procedure? Elevated right or left heart pressures Heart failure or cardiac valvular insufficiency Marked pulmonary hypertension Rapidly progressing liver failure Clinically significant hepatic encephalopathy Uncontrolled sepsis or systemic infection Unrelieved biliary obstruction Severe, uncorrectable coagulopathy Extensive hepatic malignancy (primary or secondary)
Indications for transjugular intrahepatic portosystemic shunt (TIPS) Uncontrollable variceal hemorrhage Acute or prior variceal bleeding not controlled with initial or continued endoscopic therapy Refractory ascites Prophylaxis against recurrent variceal bleeding in high-risk patients Portal hypertensive gastropathy Hepatic hydrothoraxBudd-Chiari syndrome or other venoocclusive diseases Hepatorenal syndrome Hepatopulmonary syndrome Decompression of portosystemic collaterals prior to abdominal surgeries
When might PVE be indicated in patients with cirrhosis? PVE is considered in patients with well-compensated cirrhosis (i.e., Child-Pugh [CP] class A), who are surgical resection candidates, and who have an sFLR of less than 40%. Patients with cirrhosis often demonstrate attenuated rates and degrees of hypertrophy, so it is not uncommon that PVE might …
Is PVE indicated for patients with HCC and clinically evident portal hypertension? No. Clinically evident portal hypertension is a contraindication to hepatectomy, so these patients are not candidates for major hepatic resection.