Portal hypertension in patients with cirrhosis is common and can lead to severe complications that are associated with decreased survival.Among these complications,portal hypertensive bleeding and refractory ascites i...Portal hypertension in patients with cirrhosis is common and can lead to severe complications that are associated with decreased survival.Among these complications,portal hypertensive bleeding and refractory ascites in many cases can be managed with the placement of a transjugular intrahepatic portosystemic shunt(TIPS).Current indications of TIPS placement include variceal hemorrhage refractory or recurrent to standard therapy with vasoactive drugs and endoscopic variceal ligation[1].Also,in carefully selected patients(i.e.Child-Pugh class C cirrhosis with score 10-13 and Child Turcotte Pugh(CTP)class B with active bleeding on endoscopy),early TIPS(placed within 72 hours of admission)after vasoactive drugs and endoscopic band ligation improves outcomes.This intervention reduces the risk of rebleeding among this group of high-risk patients and is associated with increased survival[2].TIPS is also a treatment of choice in patients bleeding from cardiofundal varices(GOV2 and IGV1)and ectopic varices[1].Refractory ascites is also an indication for TIPS placement.However,its efficacy is controversial in this setting.It is clear that TIPS is associated with a better control of ascites than large-volume paracentesis.That said,TIPS is followed by a greater incidence of hepatic encephalopathy.Controversial results regarding the survival benefits of TIPS have emerged and are still a matter of intense debate[3].In summary,a careful selection of candidates for TIPS placement is necessary if refractory ascites is the indication for TIPS.Specifically,TIPS can be detrimental in older patients with cardiopulmonary disease as well as in patients in CTP class C and higher Model for End Stage Liver Disease(MELD)scores.It has to be noted that most of the randomized trials evaluating survival of TIPS have been performed using bare stents[4].展开更多
文摘Portal hypertension in patients with cirrhosis is common and can lead to severe complications that are associated with decreased survival.Among these complications,portal hypertensive bleeding and refractory ascites in many cases can be managed with the placement of a transjugular intrahepatic portosystemic shunt(TIPS).Current indications of TIPS placement include variceal hemorrhage refractory or recurrent to standard therapy with vasoactive drugs and endoscopic variceal ligation[1].Also,in carefully selected patients(i.e.Child-Pugh class C cirrhosis with score 10-13 and Child Turcotte Pugh(CTP)class B with active bleeding on endoscopy),early TIPS(placed within 72 hours of admission)after vasoactive drugs and endoscopic band ligation improves outcomes.This intervention reduces the risk of rebleeding among this group of high-risk patients and is associated with increased survival[2].TIPS is also a treatment of choice in patients bleeding from cardiofundal varices(GOV2 and IGV1)and ectopic varices[1].Refractory ascites is also an indication for TIPS placement.However,its efficacy is controversial in this setting.It is clear that TIPS is associated with a better control of ascites than large-volume paracentesis.That said,TIPS is followed by a greater incidence of hepatic encephalopathy.Controversial results regarding the survival benefits of TIPS have emerged and are still a matter of intense debate[3].In summary,a careful selection of candidates for TIPS placement is necessary if refractory ascites is the indication for TIPS.Specifically,TIPS can be detrimental in older patients with cardiopulmonary disease as well as in patients in CTP class C and higher Model for End Stage Liver Disease(MELD)scores.It has to be noted that most of the randomized trials evaluating survival of TIPS have been performed using bare stents[4].
