TIPS. D Patch Royal Free Hospital London UK

Size: px
Start display at page:

Download "TIPS. D Patch Royal Free Hospital London UK"

Transcription

1 TIPS D Patch Royal Free Hospital London UK

2

3 TIPS Technique Ascites Budd Chiari Variceal Bleeding

4 Historical Experimental Development 1967 Piccone Shunt between recanalized umbilical vein and saphenous or jugular vein 1968 Rosch Transjugular portography 1979 Gutierrez TIPS 15mm PTA Balloon 1985 Palmaz TIPS Palmaz stents 1987 Rosch TIPS Z stents

5 Historical Clinical Development Radiological Portocaval Shunt 1982 Colapinto TIPS 9mm PTA balloon 1988 Richter TIPS Palmaz stent 1993 Royal Free Dr R Dick

6 TIPS Royal Free n=? Dr N Davies Radiologist Dr D Yu Radiologist Dr D Patch Hepatologist 24 hour service 7 days a week operating 1:3 on call Supported by on-call radiology registrar and x-ray staff (currently cases a year)

7 Technique: Image Guidance Pre proceedure USS, CT, MRA, During procedure CO2 wedged portography, USS, (Ideal) is for General anaesthesia and intubation TIPS

8 TIPS technique Covered stents for all 8mm for ascites, 10mm for Budd Chiari and bleeding Dilate to 6mm for ascites, 8 for bleeding, 10 for Budd Chiari?Target pressure-no-assess patient, and embolise varices-beware of low pressure varices Post TIPS follow up in era of covered stents-yes, with U/S (same time as screening for tumours) every six months

9

10

11

12 TIPS Post stent venogram If visible varices despite 12mm dilatation proceed to coil or alcohol embolization 23.2% RFH

13 TIPS technique

14 TIPS technique

15 TIPS technique

16 Stomal varices

17 Colonic Varices

18 Keep stent short although can transplant and cut the stent!

19 Biliary Fistula Covered Stent

20 TIPS Occlusion 1998 Lost to follow up Occluded TIPS Aug 2001-covered stent

21 Occluded Right TIPS-Left sided Non transplant TIPS re-bleed Aug 2001

22 TIPS for ascites Currently, our commonest indication With the least evidence Be prepared to say no! GENERALLY, avoid if Jaundiced non-alcoholic/nash Abnormal EEG

23 TIPS for ascites N Ascites recurrence Death Av number enceph TIPS % LVP % Salerno et al Gastro 2007;133:825-34

24 TIPS for Budd Chiari V unpredicatable porto-atrial shunt Leaves surgical field clean Lots of case reports 3 initial series with long term follow up Rossle (40) Perello (13) RFH (16)

25 TIPS for Budd Chiari 124 consecutive patients yr survival 88% 5 year survival 78% Prognostic index: 0.08age+0.16bili+0.63INR 7\8 with score>7 died or OLT 4/4 with ALF and score>7 died (RFH experience) Garcia Pagan et al Gadstro 2008,135;808-15

26 Budd Chiari

27 TIPS for Budd chiari

28

29 Thrombosed Portal Vein Recanalisation n=3/26 (11.5%)? Convert to transplant candidate Decompress portal hypertension Mechanical or chemical thrombolysis USS guidance very helpful RFH series 18, failed in 4 Liatsos et al 2001 Liver Transplantation 7:5:

30

31

32

33 TIPS for Variceal Bleeding

34 Mortality from variceal bleeding in a single centre (Carbonell 2004) Child Pugh A/B Child Pugh C

35 Clinical Trials for Variceal bleeding And the winner is.. The Patient (T Boyer 2007) (ps-he should live in France, or Italy, or Spain *)

36 Early shunting in management of variceal bleeding Prospective Randomised Trial of Emergency Portocaval Shunt and Emergency Medical Therapy in Unselected Cirrhotic Patients with Bleeding Varices Orloff et al Hepatology 1994;20:

37 Portal Pressure and Variceal Bleeding (Moitinho 1999) failure to control bleeding early rebleeding P<0.0004

38 Early shunting in management of variceal bleeding Monescillo et al Hepatology 2004;40: /116 HVPG>20mmHg within 24hours of variceal bleed. Randomised into urgent TIPS and standard management Early TIPS reduced failure (p=0.003) blood transfusion and use of ITU, and in-hospital and one year mortality (p<0.05) (Only one patient with Pughs A died.)

39 Early shunting in management of Variceal bleeding-mortality HR TIPS HR non-tips Low risk CP score 3/11/12 4/10/12 15/30/17 In hospital 3/26 (11%) P= /26 (38%) 3/64 5% 6 weeks 5/26 10/26% 3 I year (19%) 8/26 P=0.01 (38%) 17/26 5% 11/64 31% 65% 17%

40 HVPG PREDICTION of 5 DAY FAILURE in ACUTE VARICEAL BLEEDING (Albraldes 2008) 117 patients HVPG measured 48 h ( 4 centres) 18 (15%) failure at 5 days (vasoactive drugs,endoscopic therapy, antibiotics) HVPG 20 mmhg OR 5.4 ( ) Systolic BP 100mmHg OR 4.9 ( ) Non-alcoholic cirrhosis OR 4.9 ( ) c statistic 0.79 HVPG 20 mmhg strongly related to CP (p=0.0002) Child A 33% Child B 57% Child C 84% Replacing HVPG with Childs-Pugh Score: c statistic 0.8

41 Eraly TIPS in management of variceal bleeding N TIPS 32 Standard management 31 Death 4 16 Garcia Pagan J Hepatol 2008 ;48 (suppl 2) A992

42 Incompetence in the UK! 135 admissions with variceal bleeding 49 index bleeds 32 known to have cirrhosis 20 referred to gastro 17 attending 11 endoscoped 8 varices, 6 on beta blockers Mcleman L et al BASL 2006

43 TIPS for FHF (!) Transjugular route for portal vein hepatocyte transfusion in FHF Experience of 1(!)

44 1.50/L 0.48/L

Contraindications. Indications. Complications. Currently TIPS is considered second or third line therapy for:

Contraindications. Indications. Complications. Currently TIPS is considered second or third line therapy for: Contraindications Absolute Relative Primary prevention variceal bleeding HCC if centrally located Active congestive heart failure Obstruction all hepatic veins Thomas D. Boyer, M.D. University of Arizona

More information

GI bleeding in chronic liver disease

GI bleeding in chronic liver disease GI bleeding in chronic liver disease Stuart McPherson Consultant Hepatologist Liver Unit, Freeman Hospital, Newcastle upon Tyne and Institute of Cellular Medicine, Newcastle University. Case 54 year old

More information

Virtual Mentor American Medical Association Journal of Ethics December 2008, Volume 10, Number 12:

Virtual Mentor American Medical Association Journal of Ethics December 2008, Volume 10, Number 12: Virtual Mentor American Medical Association Journal of Ethics December 2008, Volume 10, Number 12: 805-809. CLINICAL PEARL Indications for Use of TIPS in Treating Portal Hypertension Elizabeth C. Verna,

More information

Evidence-Base Management of Esophageal and Gastric Varices

Evidence-Base Management of Esophageal and Gastric Varices Evidence-Base Management of Esophageal and Gastric Varices Rino Alvani Gani Hepatobiliary Division Department of Internal Medicine Faculty of Medicine Universitas Indonesia Cipto Mangunkusumo National

More information

Variceal bleeding. Mainz,

Variceal bleeding. Mainz, Variceal bleeding Mainz, 21.09.2008 Risk of complications 5 years 10 years Ascites 10 % 25 % HCC 10 % 25 % Bleeding < 5 % 5-10 % Enceph. < 5 % < 5 % Typical situation : Mortality 10 % to 40 % Sequence

More information

Transjugular Intrahepatic

Transjugular Intrahepatic Transjugular Intrahepatic Portosystemic Shunt (TIPS): A Clinical and Procedural Review Mark R. Werley, M.D. and John Briguglio, M.D. Lancaster Radiology Associates, Ltd. INTRODUCTION This article reviews

More information

ACUTE VARICEAL BLEEDING MULTIMODAL APPROACH

ACUTE VARICEAL BLEEDING MULTIMODAL APPROACH FALK symposium. Liver Cirrhosis: from pathophysiology to disease management Dresden, October 13-14 14 2007 ACUTE VARICEAL BLEEDING MULTIMODAL APPROACH Professor Andrew K Burroughs Hepato-biliary biliary-pancreatic

More information

AASLD PRACTICE GUIDELINE. The Role of Transjugular Intrahepatic Portosystemic Shunt in the Management of Portal Hypertension. Preamble.

AASLD PRACTICE GUIDELINE. The Role of Transjugular Intrahepatic Portosystemic Shunt in the Management of Portal Hypertension. Preamble. AASLD PRACTICE GUIDELINE The Role of Transjugular Intrahepatic Portosystemic Shunt in the Management of Portal Hypertension Thomas D. Boyer 1 and Ziv J. Haskal 2 Preamble The recommendations in this article

More information

Tranjugular Intrahepatic Portosystemic Shunt

Tranjugular Intrahepatic Portosystemic Shunt Tranjugular Intrahepatic Portosystemic Shunt Christopher Selhorst July 25, 2005 BIDMC Radiology Overview Portal Hypertension Indications, Contraindications The Procedure Case Review Complications Outcomes

More information

Michele Bettinelli RN CCRN Lahey Health and Medical Center

Michele Bettinelli RN CCRN Lahey Health and Medical Center Michele Bettinelli RN CCRN Lahey Health and Medical Center Differentiate the types of varices Identify glue preparations utilized when treating gastric varices Review the process of glue administration

More information

Case Report: Refractory variceal bleeding Christophe Hézode, Henri Mondor Hospital, Paris-Est University, Créteil, France

Case Report: Refractory variceal bleeding Christophe Hézode, Henri Mondor Hospital, Paris-Est University, Créteil, France Case Report: Refractory variceal bleeding Christophe Hézode, Henri Mondor Hospital, Paris-Est University, Créteil, France Thank you to Marika Rudler, Dominique Thabut, Adrian Gadano, and Jaime Bosch for

More information

Direct Intrahepatic Porta-Caval Shunt Technique & Tips-Tricks. Pierre GOFFETTE, MD, St-Luc University Hospital University of Leuven Brussels

Direct Intrahepatic Porta-Caval Shunt Technique & Tips-Tricks. Pierre GOFFETTE, MD, St-Luc University Hospital University of Leuven Brussels Direct Intrahepatic Porta-Caval Shunt Technique & Tips-Tricks Pierre GOFFETTE, MD, St-Luc University Hospital University of Leuven Brussels Pierre Goffette, M.D. Consultant/Advisory Board: Covidien (Neuro)

More information

Barbara Rus Gadžijev Peter Popovič Klinični inštitut za radiologijo UKC Ljubljana

Barbara Rus Gadžijev Peter Popovič Klinični inštitut za radiologijo UKC Ljubljana STROKOVNI SESTANEK ZDRUŽENJA HEMATOLOGOV SLOVENIJE IN ZDRUŽENJA ZA TRANSFUZIJSKO MEDICINO, Terme Zreče, 17.-18.4.2015 Barbara Rus Gadžijev Peter Popovič Klinični inštitut za radiologijo UKC Ljubljana goals,

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A ACLF. See Acute-on-chronic liver failure (ACLF) Acute kidney injury (AKI) in ACLF patients, 967 Acute liver failure (ALF), 957 964 causes

More information

Management of Ascites and Hepatorenal Syndrome. Florence Wong University of Toronto. June 4, /16/ Gore & Associates: Consultancy

Management of Ascites and Hepatorenal Syndrome. Florence Wong University of Toronto. June 4, /16/ Gore & Associates: Consultancy Management of Ascites and Hepatorenal Syndrome Florence Wong University of Toronto June 4, 2016 6/16/2016 1 Disclosures Gore & Associates: Consultancy Sequana Medical: Research Funding Mallinckrodt Pharmaceutical:

More information

DOTTORATO DI RICERCA IN SCIENZE MEDICO-CHIRURGICHE GASTROENTEROLOGICHE E DEI TRAPIANTI TITOLO TESI FACTORS PREDICTING MORTALITY AFTER TIPS FOR

DOTTORATO DI RICERCA IN SCIENZE MEDICO-CHIRURGICHE GASTROENTEROLOGICHE E DEI TRAPIANTI TITOLO TESI FACTORS PREDICTING MORTALITY AFTER TIPS FOR Alma Mater Studiorum Università di Bologna DOTTORATO DI RICERCA IN SCIENZE MEDICO-CHIRURGICHE GASTROENTEROLOGICHE E DEI TRAPIANTI Ciclo XXII Settore/i scientifico-disciplinare/i di afferenza: MED/12 TITOLO

More information

Esophageal Varices Beta-Blockers or Band Ligation. Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph

Esophageal Varices Beta-Blockers or Band Ligation. Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph Esophageal Varices Beta-Blockers or Band Ligation Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph Esophageal Varices Beta-Blockers or Band Ligation? Risk of esophageal variceal

More information

Portogram shows opacification of gastroesophageal varices.

Portogram shows opacification of gastroesophageal varices. Portogram shows opacification of gastroesophageal varices. http://clinicalgate.com/radiologic-hepatobiliary-interventions/ courtesyhttp://emedicine.medscape.com/article/372708-overview DR.Thulfiqar Baiae

More information

Carvedilol or Propranolol in the Management of Portal Hypertension?

Carvedilol or Propranolol in the Management of Portal Hypertension? Evidence Based Case Report Carvedilol or Propranolol in the Management of Portal Hypertension? Arranged by: dr. Saskia Aziza Nursyirwan RESIDENCY PROGRAM OF INTERNAL MEDICINE DEPARTMENT UNIVERSITY OF INDONESIA

More information

Ascites Management. Atif Zaman, MD MPH Oregon Health & Science University Professor of Medicine Division of Gastroenterology and Hepatology

Ascites Management. Atif Zaman, MD MPH Oregon Health & Science University Professor of Medicine Division of Gastroenterology and Hepatology Ascites Management Atif Zaman, MD MPH Oregon Health & Science University Professor of Medicine Division of Gastroenterology and Hepatology Disclosure 1. The speaker Atif Zaman, MD MPH have no relevant

More information

Endovascular Techniques for Symptomatic Portal Hypertension. Michael Meuse, M.D. Vascular and Interventional Radiology

Endovascular Techniques for Symptomatic Portal Hypertension. Michael Meuse, M.D. Vascular and Interventional Radiology Endovascular Techniques for Symptomatic Portal Hypertension Michael Meuse, M.D. Vascular and Interventional Radiology Objectives Review indications and contraindications for TIPS Define a treatment algorithm

More information

Transjugular intrahepatic portosystemic shunt in the treatment of symptomatic portal hypertension

Transjugular intrahepatic portosystemic shunt in the treatment of symptomatic portal hypertension Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1338 Transjugular intrahepatic portosystemic shunt in the treatment of symptomatic portal hypertension KERSTIN ROSENQVIST

More information

Management of Cirrhotic Complications Uncontrolled Ascites. Siwaporn Chainuvati, MD Siriraj Hospital Mahidol University

Management of Cirrhotic Complications Uncontrolled Ascites. Siwaporn Chainuvati, MD Siriraj Hospital Mahidol University Management of Cirrhotic Complications Uncontrolled Ascites Siwaporn Chainuvati, MD Siriraj Hospital Mahidol University Topic Definition, pathogenesis Current therapeutic options Experimental treatments

More information

th Annual AISF Meeting 44 th th th, 2011 Rome, February 23 rd -26

th Annual AISF Meeting 44 th th th, 2011 Rome, February 23 rd -26 44 th 44 th Annual AISF Meeting Rome, February 23 rd -26 th th, 2011 Update on the Baveno Consensus Conference Roberto de Franchis Department of of Clinical Sciences, University of of Milan, Head, Gastroenterology

More information

Invasive Evaluation of Portal Hypertension. Vincenzo La Mura, MD PhD Department of Biomedical Sciences for Health University of Milan

Invasive Evaluation of Portal Hypertension. Vincenzo La Mura, MD PhD Department of Biomedical Sciences for Health University of Milan Invasive Evaluation of Portal Hypertension Vincenzo La Mura, MD PhD Department of Biomedical Sciences for Health University of Milan Vincenzo La Mura, MD, PhD Dipartimento di scienze Biomediche per la

More information

TIPS in the Management of Portal Hypertension Clinician s Opinion

TIPS in the Management of Portal Hypertension Clinician s Opinion TIPS in the Management of Portal Hypertension Clinician s Opinion Oliviero Riggio 5 th AISF post meeting course Diagnostic and Therapeutic Procedures in Hepatology 2012 Oliviero Riggio Dipartimento di

More information

Clinical Study Transjugular Intrahepatic Portosystemic Shunt for the Treatment of Portal Hypertension in Noncirrhotic Patients with Portal Cavernoma

Clinical Study Transjugular Intrahepatic Portosystemic Shunt for the Treatment of Portal Hypertension in Noncirrhotic Patients with Portal Cavernoma Gastroenterology Research and Practice, Article ID 659726, 8 pages http://dx.doi.org/10.1155/2014/659726 Clinical Study Transjugular Intrahepatic Portosystemic Shunt for the Treatment of Portal Hypertension

More information

RG Volume 33 Number 5 Kirby et al 1497

RG Volume 33 Number 5 Kirby et al 1497 Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights. RG Volume 33 Number

More information

Indications, results and benefits of the measurement of hepatic venous pressure gradient

Indications, results and benefits of the measurement of hepatic venous pressure gradient Indications, results and benefits of the measurement of hepatic venous pressure gradient Poster No.: C-0976 Congress: ECR 2017 Type: Scientific Exhibit Authors: J. P. León Salinas 1, M. D. Ferrer-Puchol

More information

Primary Prophylaxis against Variceal Hemorrhage Pharmacotherapy vs Endoscopic Band Ligation

Primary Prophylaxis against Variceal Hemorrhage Pharmacotherapy vs Endoscopic Band Ligation Primary Prophylaxis against Variceal Hemorrhage Pharmacotherapy vs Endoscopic Band Ligation Siwaporn Chainuvati, MD Faculty of Medicine Siriraj Hospital Outline Natural history of esophageal varices Which

More information

VARICEAL BLEEDING. Ram Subramanian MD Hepatology & Critical Care Medical Director of Liver Transplant Emory University, Atlanta.

VARICEAL BLEEDING. Ram Subramanian MD Hepatology & Critical Care Medical Director of Liver Transplant Emory University, Atlanta. VARICEAL BLEEDING Ram Subramanian MD Hepatology & Critical Care Medical Director of Liver Transplant Emory University, Atlanta Disclosures: None OUTLINE Pathophysiology of portal hypertension Splanchnic

More information

Title: Cholestasis after TIPS placement in a patient with primary sclerosing cholangitis: an uncommon complication

Title: Cholestasis after TIPS placement in a patient with primary sclerosing cholangitis: an uncommon complication Title: Cholestasis after TIPS placement in a patient with primary sclerosing cholangitis: an uncommon complication Authors: Alejandro Salagre García, Carolina Muñoz Codoceo, Elena Gómez Domínguez, Inmaculada

More information

The Leeds Teaching Hospitals NHS Trust Transjugular Intrahepatic Portosystemic Shunt (TIPS)

The Leeds Teaching Hospitals NHS Trust Transjugular Intrahepatic Portosystemic Shunt (TIPS) n The Leeds Teaching Hospitals NHS Trust Transjugular Intrahepatic Portosystemic Shunt (TIPS) Information for patients Your liver doctor has recommended that you have a Transjugular Intrahepatic Portosystemic

More information

Acute TIPS occlusion due to iatrogenic arteriovenous shunt in a cirrhotic patient with total portal vein thrombosis

Acute TIPS occlusion due to iatrogenic arteriovenous shunt in a cirrhotic patient with total portal vein thrombosis Interventional Medicine & Applied Science, Vol. 7 (4), pp. 166 170 (2015) CASE REPORT Acute TIPS occlusion due to iatrogenic arteriovenous shunt in a cirrhotic patient with total portal vein thrombosis

More information

Diagnostic Procedures. Measurement of Hepatic venous pressure in management of cirrhosis. Clinician s opinion

Diagnostic Procedures. Measurement of Hepatic venous pressure in management of cirrhosis. Clinician s opinion 5 th AISF Post-Meeting Course Diagnostic and Therapeutic Invasive Procedures in Hepatology Rome, February 25 th Diagnostic Procedures Measurement of Hepatic venous pressure in management of cirrhosis Clinician

More information

Management of Portal Vein Thrombosis With and Without Cirrhosis

Management of Portal Vein Thrombosis With and Without Cirrhosis Management of Portal Vein Thrombosis With and Without Cirrhosis Dominique-Charles Valla Service d Hépatologie,Hôpital Beaujon, APHP, Université Paris-Diderot, Inserm CRB3 Extrahepatic Portal Vein Obstruction

More information

PORTAL HYPERTENSION. Tianjin Medical University LIU JIAN

PORTAL HYPERTENSION. Tianjin Medical University LIU JIAN PORTAL HYPERTENSION Tianjin Medical University LIU JIAN DEFINITION Portal hypertension is present if portal venous pressure exceeds 10mmHg (1.3kPa). Normal portal venous pressure is 5 10mmHg (0.7 1.3kPa),

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Acute variceal bleeding management of, 251 262 balloon tamponade of esophagus in, 257 258 endoscopic therapies in, 255 257. See also Endoscopy,

More information

Update in abdominal Surgery in cirrhotic patients

Update in abdominal Surgery in cirrhotic patients Update in abdominal Surgery in cirrhotic patients Safi Dokmak HBP department and liver transplantation Beaujon Hospital, Clichy, France Cairo, 5 April 2016 Cirrhosis Prevalence in France (1%)* Patients

More information

Controversies in Management of Portal Hypertension and Cirrhosis Complications in the Transplant Candidate

Controversies in Management of Portal Hypertension and Cirrhosis Complications in the Transplant Candidate Controversies in Management of Portal Hypertension and Cirrhosis Complications in the Transplant Candidate Patrick Northup, MD, FAASLD, FACG Medical Director, Liver Transplantation University of Virginia

More information

بسم الله الرحمن الرحيم أوتيتم من العلم إال قليال وما

بسم الله الرحمن الرحيم أوتيتم من العلم إال قليال وما بسم الله الرحمن الرحيم أوتيتم من العلم إال قليال وما 1 2 Goals of the Lecture: What is the portal vein? How common is PVT? What conditions are associated with PVT? How does patient with PVT present? How

More information

Conflict of interest disclosures. Complications of end stage liver disease. None. The many complications of Cirrhosis. Portal Hypertension.

Conflict of interest disclosures. Complications of end stage liver disease. None. The many complications of Cirrhosis. Portal Hypertension. Complications of end stage liver disease Conflict of interest disclosures None Amir Qamar, MD Instructor of Medicine Brigham and Women s s Hospital Harvard Medical School Boston, MA 02115 The many complications

More information

V ariceal haemorrhage is a major cause of mortality and

V ariceal haemorrhage is a major cause of mortality and 270 LIVER DISEASE The role of the transjugular intrahepatic portosystemic stent shunt (TIPSS) in the management of bleeding gastric : clinical and haemodynamic correlations D Tripathi, G Therapondos, E

More information

Gastro-Intestinal Bleeding- Interventional Radiology turning off the tap. Simon McPherson, Vascular Interventional Radiologist, Leeds

Gastro-Intestinal Bleeding- Interventional Radiology turning off the tap. Simon McPherson, Vascular Interventional Radiologist, Leeds Gastro-Intestinal Bleeding- Interventional Radiology turning off the tap Simon McPherson, Vascular Interventional Radiologist, Leeds Scale UK 100,000 /year Commonest Vascular IR on-call 75% UGIB 65% NVUGIB

More information

The Management of Ascites & Hepatorenal Syndrome. Florence Wong University of Toronto. Falk Symposium March 14, 2008

The Management of Ascites & Hepatorenal Syndrome. Florence Wong University of Toronto. Falk Symposium March 14, 2008 The Management of Ascites & Hepatorenal Syndrome Florence Wong University of Toronto Falk Symposium March 14, 2008 Management of Ascites Sodium Restriction Mandatory at all stages of ascites in order to

More information

JMSCR Vol 04 Issue 08 Page August 2016

JMSCR Vol 04 Issue 08 Page August 2016 www.jmscr.igmpublication.org Impact Factor 5.244 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: http://dx.doi.org/10.18535/jmscr/v4i8.23 Portal Hypertension in Adults- A Comprehensive

More information

Obliterative hepatocavopathy ultrasound and cavography findings

Obliterative hepatocavopathy ultrasound and cavography findings doi:10.2478/v10019-008-0020-6 case report Obliterative hepatocavopathy ultrasound and cavography findings Ramazan Kutlu Department of Radiology, Inonu University School of Medicine, Malatya, Turkey ackgound.

More information

Within-patient temporal variance in MELD score and impact on survival prediction after TIPS creation

Within-patient temporal variance in MELD score and impact on survival prediction after TIPS creation Survival prediction after TIPS creation., 2013; 12 (5): 797-802 ORIGINAL ARTICLE September-October, Vol. 12 No.5, 2013: 797-802 797 Within-patient temporal variance in MELD score and impact on survival

More information

Eun-Ju Kang, M.D., Seong Kuk Yoon, M.D., Sang-Hyeon Kim, M.D., Jin Han Cho, M.D., Myong Jin Kang, M.D., Byeong-Ho Park, M.D.

Eun-Ju Kang, M.D., Seong Kuk Yoon, M.D., Sang-Hyeon Kim, M.D., Jin Han Cho, M.D., Myong Jin Kang, M.D., Byeong-Ho Park, M.D. Bleeding from an Ileal Conduit Stomal Varix: Diagnosis with Three- Dimmensional Volume Rendered Images by the use of Multidetector-Row CT (MDCT) and Management with a Transjugular Intrahepatic Portosystemic

More information

Measurements of portal pressure have wide

Measurements of portal pressure have wide Right Atrial Pressure Is Not Adequate to Calculate Portal Pressure Gradient in Cirrhosis: A Clinical-Hemodynamic Correlation Study Vincenzo La Mura, Juan G. Abraldes, Annalisa Berzigotti, Eva Erice, Alexandra

More information

Complication of Portal Hypertension: should the patients in the waiting list be treated differently?

Complication of Portal Hypertension: should the patients in the waiting list be treated differently? Wilma Debernardi Venon Gastroepatologia, Az. Osp. San Giovanni Battista ditorino Complication of Portal Hypertension: should the patients in the waiting list be treated differently? Il sottoscritto dichiara

More information

Acute Upper Gastrointestinal Hemorrhage Surgical Perspective. Dr.J.H.Barnard Dept. of Surgery PAH

Acute Upper Gastrointestinal Hemorrhage Surgical Perspective. Dr.J.H.Barnard Dept. of Surgery PAH Acute Upper Gastrointestinal Hemorrhage Surgical Perspective Dr.J.H.Barnard Dept. of Surgery PAH Introduction: AGH is a leading cause of admissions into ICU. Overall mortality 5-12%, but increases to 40%

More information

Interventional treatment of mesenteric venous occlusion.

Interventional treatment of mesenteric venous occlusion. Interventional treatment of mesenteric venous occlusion. Wichman, Heather J; Cwikiel, Wojciech; Keussen, Inger Published in: Polish journal of radiology / Polish Medical Society of Radiology DOI: 10.12659/PJR.890990

More information

ICU Volume 14 - Issue 2 - Summer Matrix

ICU Volume 14 - Issue 2 - Summer Matrix ICU Volume 14 - Issue 2 - Summer 2014 - Matrix Upper Gastrointestinal Bleeding Authors David Osman, MD Medical Intensive Care Unit Paris-South University Hospitals Assistance Publique-Hôpitaux de Paris

More information

Management of Cirrhosis Related Complications

Management of Cirrhosis Related Complications Management of Cirrhosis Related Complications Ke-Qin Hu, MD, FAASLD Professor of Clinical Medicine Director of Hepatology University of California, Irvine Disclosure I have no disclosure related to this

More information

The Yellow Patient. Dr Chiradeep Raychaudhuri, Consultant Hepatologist, Hull University Teaching Hospitals NHS Trust

The Yellow Patient. Dr Chiradeep Raychaudhuri, Consultant Hepatologist, Hull University Teaching Hospitals NHS Trust The Yellow Patient Dr Chiradeep Raychaudhuri, Consultant Hepatologist, Hull University Teaching Hospitals NHS Trust there s a yellow patient in bed 40. It s one of yours. Liver Cirrhosis Why.When.What.etc.

More information

Decompensated chronic liver disease

Decompensated chronic liver disease Decompensated chronic liver disease Definition of decompensated chronic liver disease Patients with chronic liver disease can present with acute decompensation due to various causes. The decompensation

More information

Manejo Actual del Sangrado por Varices Gástricas

Manejo Actual del Sangrado por Varices Gástricas Manejo Actual del Sangrado por Varices Gástricas Juan Carlos Garcia-Pagán Barcelona Hepatic Hemodynamic Laboratory. Liver Unit. IMDIM. Hospital Clinic. IDIBAPS. Ciberehd. XXIV Congreso de la Asociación

More information

Preoperative elective transjugular intrahepatic portosystemic shunt for cirrhotic patients undergoing abdominal surgery

Preoperative elective transjugular intrahepatic portosystemic shunt for cirrhotic patients undergoing abdominal surgery REVIEW ARTICLE Annals of Gastroenterology (2017) 31, 330-337 Preoperative elective transjugular intrahepatic portosystemic shunt for cirrhotic patients undergoing abdominal Deepanshu Jain a, Ejaz Mahmood

More information

Left-sided portal hypertension with a patent splenic vein: An impossible or a not-so-uncommon scenario?

Left-sided portal hypertension with a patent splenic vein: An impossible or a not-so-uncommon scenario? Khan et al. 108 CASE REPORT PEER REVIEWED OPEN ACCESS Left-sided portal hypertension with a patent splenic vein: An impossible or a not-so-uncommon scenario? Iftikhar Khan, Ghassan Ramahi, Saif Zaabi,

More information

Journal of Radiology and Imaging

Journal of Radiology and Imaging Journal of Radiology and Imaging http://dx.doi.org/10.14312/2399-8172.2018-1 Original research Open Access Usefulness of a balloon-expandable, covered stent for the transjugular intrahepatic portosystemic

More information

Prof. Mohammad Umar. MBBS, MCPS, FCPS, FACG (USA), FRCP (London), FRCP (Glasgow), FAGA

Prof. Mohammad Umar. MBBS, MCPS, FCPS, FACG (USA), FRCP (London), FRCP (Glasgow), FAGA Prof. Mohammad Umar MBBS, MCPS, FCPS, FACG (USA), FRCP (London), FRCP (Glasgow), FAGA Chairman and Head Department of Medicine Rawalpindi Medical College, Rawalpindi. Consultant Gastroenterologist / Hepatologist

More information

Preliminary study of the permeability and safety of covered stents-grafts in pediatric TIPS

Preliminary study of the permeability and safety of covered stents-grafts in pediatric TIPS Preliminary study of the permeability and safety of covered stents-grafts in pediatric TIPS Poster No.: C-0354 Congress: ECR 2013 Type: Scientific Exhibit Authors: A. Bueno Palomino, L. Zurera Tendero,

More information

MANAGEMENT OF LIVER CIRRHOSIS: PRACTICE ESSENTIALS AND PATIENT SELF-MANAGEMENT

MANAGEMENT OF LIVER CIRRHOSIS: PRACTICE ESSENTIALS AND PATIENT SELF-MANAGEMENT MANAGEMENT OF LIVER CIRRHOSIS: PRACTICE ESSENTIALS AND PATIENT SELF-MANAGEMENT Sherona Bau, ACNP The Pfleger Liver Institute 200 UCLA Medical Plaza, Suite 214 Los Angeles, CA 90095 September 30, 2017 I

More information

Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunt (TIPS) Cardiovasc Intervent Radiol (2012) 35:1295 1300 DOI 10.1007/s00270-012-0493-y CIRSE STANDARDS OF PRACTICE GUIDELINES Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunt (TIPS)

More information

Collateral Pathways in Budd Chiari Syndrome- MDCT Depiction

Collateral Pathways in Budd Chiari Syndrome- MDCT Depiction Review Article imedpub Journals http://www.imedpub.com/ http://dx.doi.org/10.4172/ijdd.1000025 Collateral Pathways in Budd Chiari Syndrome- MDCT Depiction Abstract Budd Chiari syndrome (BCS) is a condition

More information

DRAFT. Angiography: Transjugular Intrahepatic Portosystemic Shunt (TIPS) What to expect. What is a transjugular intrahepatic portosystemic shunt?

DRAFT. Angiography: Transjugular Intrahepatic Portosystemic Shunt (TIPS) What to expect. What is a transjugular intrahepatic portosystemic shunt? UW MEDICINE PATIENT EDUCATION Angiography: Transjugular Intrahepatic Portosystemic Shunt (TIPS) What to expect This handout explains a transjugular intrahepatic portosystemic shunt and what to expect when

More information

Denver Shunts vs TIPS for Ascites

Denver Shunts vs TIPS for Ascites Denver Shunts vs TIPS for Ascites Hooman Yarmohammadi MD Assistant Professor of Radiology Interventional Radiology & Image Guided Therapies Memorial Sloan-Kettering Cancer Center, New York, USA Hooman

More information

NYU School of Medicine Department of Radiology Rotation-Specific House Staff Evaluation

NYU School of Medicine Department of Radiology Rotation-Specific House Staff Evaluation Vascular & Interventional Radiology Rotation 1 Core competency in vascular and interventional radiology during the first resident rotation consists of clinical objectives, technical objectives and image

More information

Transcaval TIPS in Patients with Failed Revision of Occluded Previous TIPS

Transcaval TIPS in Patients with Failed Revision of Occluded Previous TIPS Transcaval TIPS in Patients with Failed Revision of Occluded Previous TIPS Chang Kyu Seong, MD Yong Joo Kim, MD Tae Beom Shin, MD Hyo Yong Park, MD Tae Hun Kim, MD Duk Sik Kang, MD Index terms: Hypertension,

More information

Hepatocellular carcinoma: Intra-arterial treatments

Hepatocellular carcinoma: Intra-arterial treatments Hepatocellular carcinoma: Intra-arterial treatments Irene Bargellini U.O. Radiologia Interventistica Azienda Ospedaliero Universitaria Pisana IRENE BARGELLINI,MD UO RADIOLOGIA INTERVENTISTICA, AZIENDA

More information

Portal hypertension and ascites

Portal hypertension and ascites Portal hypertension and ascites Muhammad S Mirza Guruprasad P Aithal Abstract Portal pressure is the product of portal blood flow and resistance; an increase in either leads to increased portal pressure.

More information

BRTO: Updates to Techniques

BRTO: Updates to Techniques Session XIV: BRTO, PARTO and Portal Hypertension GEST2016 BRTO: Updates to Techniques Hiro Kiyosue Oita University Hospital, Japan Hiro Kiyosue, MD Royalty: Cook, Medkit Consulting Fee: Stryker Japan,

More information

BRTO /PARTO Indications and outcomes

BRTO /PARTO Indications and outcomes BRTO /PARTO Indications and outcomes Saher Sabri, MD Associate Professor of Radiology and Surgery Division of Interventional Radiology University of Virginia Health System Saher Sabri, M.D. Speakers Bureau:

More information

Longterm follow up of transjugular intrahepatic portosystemic stent shunt (TIPSS) for the treatment of portal hypertension: results in 130 patients

Longterm follow up of transjugular intrahepatic portosystemic stent shunt (TIPSS) for the treatment of portal hypertension: results in 130 patients Gut 1996; 39: 479-485 Departments of Medicine A J Stanley R Jalan E H Forrest P C Hayes and Radiology D N Redhead Royal Infirmary of Edinburgh, Edinburgh Correspondence to: Dr A J Stanley, Department of

More information

Filippo Schepis, MD Università degli Studi di Modena e Reggio Emilia

Filippo Schepis, MD Università degli Studi di Modena e Reggio Emilia Filippo Schepis, MD Università degli Studi di Modena e Reggio Emilia Il sottoscritto dichiara di non aver avuto/di aver avuto negli ultimi 12 mesi conflitto d interesse in relazione a questa presentazione

More information

D. Debray, Hépatologie pédiatrique Hôpital Bicêtre

D. Debray, Hépatologie pédiatrique Hôpital Bicêtre D. Debray, Hépatologie pédiatrique Hôpital Bicêtre LUNG LIVER GUT AND PORTAL SYSTEM Hepatopulmonary syndrome (HPS) Portopulmonary hypertension (PPH) HEPATOPULMONARY SYNDROME Defect in arterial oxygenation

More information

Interventional Radiology Curriculum for Medical Students

Interventional Radiology Curriculum for Medical Students Cardiovascular and Interventional Radiological Society of Europe Interventional Radiology Curriculum for Medical Students C RSE Introduction It has been recognized that the teaching of radiology in medical

More information

European. Young Hepatologists Workshop. Organized by : Quantification of fibrosis and cirrhosis outcomes

European. Young Hepatologists Workshop. Organized by : Quantification of fibrosis and cirrhosis outcomes supported by from Gilea Quantification of fibrosis and cirrhosis outcomes th 5 European 5 European Young Hepatologists Workshop Young Hepatologists Workshop August, 27-29. 2015, Moulin de Vernègues Vincenza

More information

Prior Authorization Review Panel MCO Policy Submission

Prior Authorization Review Panel MCO Policy Submission Prior Authorization Review Panel MCO Policy Submission A separate copy of this form must accompany each policy submitted for review. Policies submitted without this form will not be considered for review.

More information

Transjugular Intrahepatic Portosystemic Shunt in Patients with Active Variceal Bleeding Due to Portal Hypertension and Portal Vein Thrombosis I

Transjugular Intrahepatic Portosystemic Shunt in Patients with Active Variceal Bleeding Due to Portal Hypertension and Portal Vein Thrombosis I J Korean Radiol Soc 1997; 37 : 597-603 Transjugular Intrahepatic Portosystemic Shunt in Patients with Active Variceal Bleeding Due to Portal Hypertension and Portal Vein Thrombosis I Hyun Woong Shin, M.D.,

More information

edigraphic.com Otras secciones de este sitio: Others sections in this web site: ! Contents of this number! More journals! Search

edigraphic.com Otras secciones de este sitio: Others sections in this web site: ! Contents of this number! More journals! Search ANNALS OF HEPATOLOGY Volume 5 Number 1 January-March 2006 Artículo: The use of TIPS in chronic liver disease Copyright 2006: Mexican Association of Hepatology Otras secciones de este sitio:! Índice de

More information

Transjugular Intrahepatic Portosystemic Shunt Reduction for Management of Recurrent Hepatic Encephalopathy

Transjugular Intrahepatic Portosystemic Shunt Reduction for Management of Recurrent Hepatic Encephalopathy CLINICAL IMAGES Ochsner Journal 17:311 316, 2017 Ó Academic Division of Ochsner Clinic Foundation Transjugular Intrahepatic Portosystemic Shunt Reduction for Management of Recurrent Hepatic Encephalopathy

More information

LIVER CIRRHOSIS. The liver extracts nutrients from the blood and processes them for later use.

LIVER CIRRHOSIS. The liver extracts nutrients from the blood and processes them for later use. LIVER CIRRHOSIS William Sanchez, M.D. & Jayant A. Talwalkar, M.D., M.P.H. Advanced Liver Disease Study Group Miles and Shirley Fiterman Center for Digestive Diseases Mayo College of Medicine Rochester,

More information

Transjugular Intrahepatic Portosystemic Shunt

Transjugular Intrahepatic Portosystemic Shunt 카J Korean Radiol Soc 1997; 36 : 37-42 Transjugular Intrahepatic Portosystemic Shunt Results and Prognostic Factors in Patients with Post-necrotic Liver Cirrhosis 1 Jae Hyung Park, M.D., Yong Joo Kim, M.D.

More information

Noncirrhotic Portal Hypertension: Imaging, Hemodynamics, and Endovascular Therapy

Noncirrhotic Portal Hypertension: Imaging, Hemodynamics, and Endovascular Therapy REVIEW Noncirrhotic Portal Hypertension: Imaging, Hemodynamics, and Endovascular Therapy Venkatesh P. Krishnasamy, M.D.,* Michael J. Hagar, M.D., Albert K. Chun, M.D., M.B.A., and Elliot Levy, M.D. Patients

More information

V ariceal bleeding is a serious complication of portal

V ariceal bleeding is a serious complication of portal 431 LIVER Randomised controlled trial of long term portographic follow up versus variceal band ligation following transjugular intrahepatic portosystemic stent shunt for preventing oesophageal variceal

More information

ACG & AASLD Joint Clinical Guideline: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis

ACG & AASLD Joint Clinical Guideline: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis ACG & AASLD Joint Clinical Guideline: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis Guadalupe Garcia-Tsao, M.D., 1 Arun J. Sanyal, M.D., 2 Norman D. Grace,

More information

6 th August 2018 Day 1 - Gallbladder & Bile duct Topic

6 th August 2018 Day 1 - Gallbladder & Bile duct Topic Venue: Sterling Hospital Auditorium, Sterling Hospitals, Gurukul Road Ahmedabad, Gujarat 6 th August 2018 Day 1 - Gallbladder & Bile duct Registration(8:00am-8:15am) Inauguration(8:15am-8:30am) Welcome

More information

Transjugular intrahepatic portosystemic shunt (TIPS) Information for patients Sheffield Vascular Institute

Transjugular intrahepatic portosystemic shunt (TIPS) Information for patients Sheffield Vascular Institute Transjugular intrahepatic portosystemic shunt (TIPS) Information for patients Sheffield Vascular Institute You have been given this leaflet because you need a procedure called a transjugular intrahepatic

More information

Beta-blockers in cirrhosis: Cons

Beta-blockers in cirrhosis: Cons Beta-blockers in cirrhosis: Cons Eric Trépo MD, PhD Dept. of Gastroenterology. Hepatopancreatology and Digestive Oncology. C.U.B. Hôpital Erasme. Université Libre de Bruxelles. Bruxelles. Belgium Laboratory

More information

Surveillance for Hepatocellular Carcinoma

Surveillance for Hepatocellular Carcinoma Surveillance for Hepatocellular Carcinoma Marion G. Peters, MD John V. Carbone, MD, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco Recorded on April

More information

The Role of TIPS for Portal Vein Patency in Liver Transplant Patients With Portal Vein Thrombosis

The Role of TIPS for Portal Vein Patency in Liver Transplant Patients With Portal Vein Thrombosis LIVER TRANSPLANTATION 12:1544-1551, 2006 SHORT REPORT The Role of TIPS for Portal Vein Patency in Liver Transplant Patients With Portal Vein Thrombosis Jason Bauer, 1 Stephen Johnson, 1 Janette Durham,

More information

CARLO MERKEL, MASSIMO BOLOGNESI, DAVID SACERDOTI, GIANCARLO BOMBONATO, BARBARA BELLINI, RAFFAELLA BIGHIN, AND ANGELO GATTA

CARLO MERKEL, MASSIMO BOLOGNESI, DAVID SACERDOTI, GIANCARLO BOMBONATO, BARBARA BELLINI, RAFFAELLA BIGHIN, AND ANGELO GATTA The Hemodynamic Response to Medical Treatment of Portal Hypertension as a Predictor of Clinical Effectiveness in the Primary Prophylaxis of Variceal Bleeding in Cirrhosis CARLO MERKEL, MASSIMO BOLOGNESI,

More information

Initial approach to ascites

Initial approach to ascites Ascites: Filling and Draining the Water Balloon Common Pathogenesis in Refractory Ascites, Hyponatremia, and Cirrhosis intrahepatic resistance sinusoidal portal hypertension Splanchnic vasodilation (effective

More information

Transjugular intrahepatic portosystemic shunt and liver transplantation

Transjugular intrahepatic portosystemic shunt and liver transplantation Transpl Int (1996) 9: 370-375 Springer-Verlag 1996 O R IG IN A L A R TIC LE Transjugular intrahepatic portosystemic shunt and liver transplantation Jan P. Lerut Pierre-Franois Laterre»,. PierreGoffeMe

More information

Clinical Trials & Endpoints in NASH Cirrhosis

Clinical Trials & Endpoints in NASH Cirrhosis Clinical Trials & Endpoints in NASH Cirrhosis April 25, 2018 Peter G. Traber, MD CEO & CMO, Galectin Therapeutics 2018 Galectin Therapeutics NASDAQ: GALT For more information, see galectintherapeutics.com

More information

Current status of transjugular

Current status of transjugular Postgrad MedJ7 1998;74:716-720 C The Fellowship of Postgraduate Medicine, 1998 New techniques in medicine Summary The use of the transjugular intrahepatic portosystemic shunt (TIPS) has emerged as an important

More information

Treatment of portal hypertension in the light of the Baveno VI Consensus Conference

Treatment of portal hypertension in the light of the Baveno VI Consensus Conference r e v I E w A R T I C l e S Curierul medical, December 2015, Vol. 58, No 6 Treatment of portal hypertension in the light of the Baveno VI Consensus Conference E. Tcaciuc Department of Internal Medicine,

More information