Transjugular Intrahepatic Portosystemic Shunt - PowerPoint PPT Presentation

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Transjugular Intrahepatic Portosystemic Shunt

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occlusion, or complete blockage, of the stent and rapid recurrence of symptoms ... infection of the stent. intra-abdominal bleeding. heart arrhythmias or ... – PowerPoint PPT presentation

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Title: Transjugular Intrahepatic Portosystemic Shunt


1
Transjugular Intrahepatic Portosystemic Shunt
Supervised by VS ????? Presented by R1 ???
2
Introduction
TIPS A procedure Tubular metal device
stent Hepatic vein ? shunt ? Portal vein ?
Portal HTN
3
Introduction
4
Introduction - EV
  • Drugs Therapy Beta-blockers or long-acting
    nitrates
  • Other drugs
    Terlipressin, Vasopressin,

  • NTG, Octreotide

  • Somatostatin.
  • Variceal Band Ligation
  • Sclerotherapy
  • TIPS
  • DSRS
  • Liver Transplant

5
Introduction
Portocaval shunt
Splenorenal shunt
6
Introduction
7
American Association for the Study of Liver
Diseases
8
The Procedure
9
The Procedure
10
The Procedure
  • Purpose of TIPS
  • decompress the portal venous system
  • prevent rebleeding from varices or stop or reduce
    the formation of ascites.
  • Hepatic venous pressure gradient (HVPG)
  • can be reduced to less than 12 mm Hg, the risk of
    bleeding will fall significantly.
  • but at the cost of an increased incidence of
    encephalopathy.
  • for the control of refractory ascites is even
    less clear (less than 8 mm Hg)

11
Contraindications
12
Indications
13
Complications
  • Possible complications of the procedure
  • allergic reaction of contrast material
  • muscle stiffness in the neck
  • bruising on the neck at the point of catheter
    insertion
  • Puncture site infection
  • Serious complications
  • occlusion, or complete blockage, of the stent and
    rapid recurrence of symptoms
  • infection of the stent
  • intra-abdominal bleeding
  • heart arrhythmias or congestive heart failure
  • hepatic encephalopathy
  • hepatic failure

14
Complications
15
(No Transcript)
16
Conclusions
  • Once a TIPS is created, frequent monitoring by
    Doppler ultrasound (TIPS dysfunction)
  • TIPS effectively
  • prevent rebleeding from varices
  • decrease the need for repeat thoracentesis in
    pts with hepatic hydrothorax or for large-volume
    paracentesis in pts with refractory ascites.
  • But, it increase incidence of hepatic
    encephalopathy and will not improve survival

17
Conclusions
  • TIPS should not be considered as primary therapy
    for any complication of portal hypertension with
    the exception of bleeding gastric or ectopic
    varices.
  • TIPS should only be created when the patient has
    failed other forms of medical therapy (i.e.,
    pharmacological or endoscopic therapy, diuretics,
    or repeated large-volume paracentesis or
    thoracentesis).
  • In pts with good liver function and recurrent
    bleeding from varices despite medical treatment,
    it is unclear whether a surgical shunt orTIPS is
    the better form of therapy pending the
    publication of additional controlled trials.
  • Budd-Chiari syndrome are best managed by TIPS
    remains undefined, although creation of
  • a TIPS in select patients may be of
    benefit.
  • Creation of a TIPS for the treatment of
    hepatorenal syndrome or hepatopulmonary syndrome
    is of unproven benefit and should be considered
    investigatory.

18
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