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Interventional Radiology in the Treatment of Portal Hypertension

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Vascular Liver Disease

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Abstract

Interventional radiology techniques, namely embolization and shunting, were developed mainly to deal with the failures of drug and/or endoscopic treatments. Among those techniques, the transjugular intrahepatic portosystemic shunt (TIPS) is the only that aims to normalize portal pressure and is therefore able to treat both refractory bleeding and intractable ascites. Embolization of esophago-gastric or ectopic varices, balloon occluded retrograde transvenous obliteration of varices, or partial splenic embolization have been poorly evaluated. Severe complications may be observed and since portal hypertension is maintained or even increased, these procedures have only a transient effect with a high rebleeding rate. Their role should be explored in patients with uncontrolled variceal hemorrhage who have a contraindication for TIPS, such as pulmonary arterial hypertension, congestive heart failure, liver failure, or severe or recurrent encephalopathy. Nowadays, TIPS should be performed using PTFE-covered prostheses, which were shown to decrease the rate of shunt dysfunction and improve clinical outcomes. TIPS has been found more effective than drug and/or endoscopic treatments in controlling active variceal bleeding as well as in preventing rebleeding, though survival was not improved and encephalopathy was more frequent. It can also be used for gastric or ectopic varices. In refractory ascites, TIPS was shown to be more effective than large ­volume paracenteses. It has also been successfully used in hydrothorax.

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  1. Hepato-Gastro-Enterologie, University of Toulouse, CHU Toulouse-Purpan, Place du Dr Baylac, Toulouse, 31059, France

    Jean-Pierre Vinel

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    Laurie D. DeLeve

  2. , Section of Digestive Diseases, Yale University School of Medicine, New Haven, 06520, Connecticut, USA

    Guadalupe Garcia-Tsao

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Bureau, C., Otal, P., Vinel, JP. (2011). Interventional Radiology in the Treatment of Portal Hypertension. In: DeLeve, L., Garcia-Tsao, G. (eds) Vascular Liver Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-8327-5_15

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