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Archive » 2016 » 4 » | Archive » Medical field » Fields » Radiology »

Transjugular Intrahepatic Portosystemic Shunt

 
Abstract:

This post is also available in: enEnglish slSlovenščina (Slovenian)

The paper provides a review of indications and contraindications for transjugular intrahepatic portosystemic shunt, which can be divided into absolute and relative. Absolute indications are acute and refractory bleeding of gastroesophageal varices and refractory ascites or hepatic hydrothorax. Transjugular intrahepatic portosystemic shunt should not be used as a first-line treatment and it should be limited to those whose therapy fails. Relative indications, on the other hand, are portal hypertensive gastropathy, portal vein thrombosis with or without cavernomatous transformation, liver transplantation, hepatopulmonary syndrom, Budd-Chiari syndrome, and hepatorenal syndrome. Transjugular intrahepatic portosystemic shunt is absolutely contraindicated in cases of unproven portal hypertension (either clinically or anatomically). Relative contraindications are Child-Pugh score 12 or more, MELD (Model for End-stage Liver Disease) score 18 or more, polycystic liver disease, diabetes, hepatic tumors, hepatic encephalopathy (especially in patients older than 60), right-sided heart failure with elevation of central venous pressure, and active infection, either intrahepatic or systemic. Before the transjugular intrahepatic portosystemic shunt procedure, the level of dysfunction of the liver, right heart and kidney is determined. Biochemical and blood tests, including a blood coagulation test, are made and possible obstructions/strictures of the portal vein are checked. The technical success rate of the procedure is 95%, and clinical success rate is more than 90%. There are relatively few complications during the procedure. Postoperative complications are more frequent due to stricture and obstruction of the shunt. The major disadvantage of transjugular intrahepatic portosystemic shunt remains their poor long-term patency and hepatic encephalopathy requiring a mandatory surveillance program.

Authors:
Popovič Peter

Keywords:
portal hypertension, complications, treatment, transjugular intrahepatic portosystemic shunt

Cite as:
Med Razgl. 2016; 55 (4): 437–47.

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