Transjugular intrahepatic portosystemic shunt (TIPS): current indications and strategies to improve the outcomes
| Autor: | Fabrizio Fanelli, Giacomo Laffi, Silvia Aspite, Francesco Vizzutti, Gabriele Dragoni, Fabio Marra, Stefano Gitto, Filippo Schepis, Umberto Arena, Laura Turco |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Hepatorenal syndrome Hypertension Portal Outcome Assessment Health Care Ascites Internal Medicine medicine Humans 030212 general & internal medicine Hepatic encephalopathy Vascular disease business.industry Heart failure Variceal bleeding Portasystemic Shunt Transjugular Intrahepatic Treatment Outcome medicine.disease Portal vein thrombosis Surgery Emergency Medicine Portal hypertension medicine.symptom business Transjugular intrahepatic portosystemic shunt Abdominal surgery |
| Zdroj: | Internal and Emergency Medicine. 15:37-48 |
| ISSN: | 1970-9366 1828-0447 |
| DOI: | 10.1007/s11739-019-02252-8 |
| Popis: | Transjugular intrahepatic portosystemic shunt (TIPS) represents a very effective treatment of complications of portal hypertension. Established indications to TIPS in cirrhotic patients include portal hypertensive bleeding and refractory ascites. Over the years additional indications have been proposed, such as the treatment of vascular disease of the liver, hepatic hydrothorax, hepatorenal syndrome and bleeding from ectopic varices. Indications under evaluation include treatment of portal hypertension prior to major abdominal surgery and treatment of portal vein thrombosis. In spite of these advances, there are still uncertainties regarding the appropriate workup for patients to be scheduled for TIPS. Moreover, prevention and management of post-TIPS complications including hepatic encephalopathy and heart failure are still suboptimal. These issues are particularly relevant considering aging in TIPS candidates in Western countries. Correct selection of patients is mandatory to prevent complications which may eventually frustrate the good hemodynamic results and worsen the patient's quality of life or even life expectancy. The possible role of small diameter TIPS to prevent post-procedural complications is discussed. |
| Databáze: | OpenAIRE |
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