摘要
Acute variceal bleeding(AVB)is associated with signifi-cant short-term morbidity and mortality.Pre-emptive tran-sjugular intrahepatic portosystemic shunt(p-TIPSS)is recommended to prevent rebleeding in AVB patients with a high risk of rebleeding.Despite the benefit of prevent-ing rebleeding and de-novo ascites,the uptake of p-TIPSS remains low because logistic challenges in the real-world setting.In this review,we summarize the current evidence and controversies on p-TIPSS including patient selection for p-TIPSS,particularly in the setting of NASH cirrhosis and acute-on-chronic liver failure,the role of sarcopenia,renal impairment in the setting of p-TIPSS.Finally,we summarize both pharmacological and nonpharmacological strategies to optimize outcomes in patients undergoing p-TIPSS.
