An Algorithm for Management After Transjugular Intrahepatic Portosystemic Shunt Placement According to Clinical Manifestations

Seung Kwon Kim, Bryan G. Belikoff, Carlos J. Guevara, Seong Jin Park

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

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.

Original languageEnglish
Pages (from-to)305-318
Number of pages14
JournalDigestive diseases and sciences
Volume62
Issue number2
DOIs
StatePublished - Feb 1 2017

Keywords

  • Balloon occlusion
  • Gastric varices
  • Portal hypertension
  • Portosystemic shunt

Fingerprint

Dive into the research topics of 'An Algorithm for Management After Transjugular Intrahepatic Portosystemic Shunt Placement According to Clinical Manifestations'. Together they form a unique fingerprint.

Cite this