Indications for percutaneous nephrostomy (PCN) • To relieve obstruction in the setting of infection or to preserve renal function. • To assist in the removal of a calculus or foreign body. • To divert urine to permit healing of a leak or fistula. • To provide access for ureteral intervention.
What are the short term and long term goals of TIPS creation? Successful TIPS creation is associated with a final portosystemic pressure gradient measurement of <12 mm Hg to prevent variceal bleeding or ascites. Successful TIPS creation will prevent variceal bleeding in greater than 90% of cases and will improve or eliminate ascites in greater than 80%. …
Potential complications of TIPS creation Complications include hemorrhage, infection, allergic reaction or renal failure due to contrast material, cardiac dysrhythmia, and respiratory failure or aspiration because of intraprocedural sedation. In addition, because the TIPS causes shunting of portal venous blood away from the liver, the procedure may be complicated by a decline in liver function …
Steps of the TIPS procedure • A hepatic vein, most commonly the right hepatic vein, is accessed via a right internal jugular vein approach. A wedged hepatic venogram may be obtained to opacify the portal vein and map its location. • A stiff metal cannula is placed, and a needle is passed from the right hepatic vein …
What are the contraindications to TIPS creation? A pre-TIPS total bilirubin level >3 mg/dL, refractory coagulopathy with an international normalized ratio >1.8, a Child-Pugh score >12, and a serum creatinine level >1.9 mg/dL all have been found to be associated with poor outcomes in studies. However, model for end-stage liver disease (MELD) score prior to TIPS has …
Indications for creating a transjugular intrahepatic portosystemic shunt (TIPS) TIPS creation is frequently performed to prevent recurrent variceal bleeding related to portal hypertension. Other indications include refractory ascites or hepatic hydrothorax, Budd-Chiari syndrome, portal hypertensive gastropathy, and hepatorenal or hepatopulmonary syndrome. TIPS placement may be an effective bridge to liver transplantation for patients with end-stage …
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How to indirectly estimate portal venous pressure to confirm the diagnosis of portal hypertension? Catheterization of a hepatic vein is performed via jugular or femoral vein access. The catheter is advanced until it obstructs a small hepatic vein branch, or a balloon occlusion catheter is inflated within the hepatic vein to obstruct its outflow. The …
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