Current diagnosis and management of post-transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy.

Autor: Pereira K; Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, FL, USA., Carrion AF; Division of Hepatology, Jackson Memorial Hospital, University of Miami Hospital, Miami, FL, USA., Martin P; Division of Hepatology, Jackson Memorial Hospital, University of Miami Hospital, Miami, FL, USA., Vaheesan K; Department of Interventional Radiology, Saint Louis University School of medicine, St Louis, MO, USA., Salsamendi J; Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, FL, USA., Doshi M; Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, FL, USA., Yrizarry JM; Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, FL, USA.
Jazyk: angličtina
Zdroj: Liver international : official journal of the International Association for the Study of the Liver [Liver Int] 2015 Dec; Vol. 35 (12), pp. 2487-94. Date of Electronic Publication: 2015 Sep 28.
DOI: 10.1111/liv.12956
Abstrakt: Transjugular intrahepatic portosystemic shunt has evolved into an important option for management of complications of portal hypertension. The use of polytetrafluoroethylene covered stents enhances shunt patency. Hepatic encephalopathy (HE) remains a significant problem after TIPS placement. The approach to management of patients with refractory hepatic encephalopathy typically requires collaboration between different specialties. Patient selection for TIPS requires careful evaluation of risk factors for HE. TIPS procedure-related technical factors like stent size, attention to portosystemic pressure gradient reduction and use of adjunctive variceal embolization maybe important. Conservative medical therapy in combination with endovascular therapies often results in resolution or substantial reduction of symptoms. Liver transplantation is, however, the ultimate treatment.
(© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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