Endovascular Treatment of Portal Hypertension

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Endovascular therapies have largely replaced surgical treatment in the management of portal hypertension in current practice. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective tool for portal decompression and can be used to treat sequela of portal hypertension, including variceal bleeding, bleeding related to portal hypertensive gastropathy, refractory acites and hepatic hydrothorax. Other endovascular techniques such as balloon-occluded retrograde transvenous obliteration (BRTO), have demonstrated promising results in treating bleeding gastric varices, which are notoriously difficult to treat via endoscopy and may respond less effectively to TIPS. Endovascular therapies such as catheter-directed thrombolysis, venous stenting, and TIPS have proven useful in the treatment of Budd-Chiari syndrome (BCS). Portosystemic shunting can induce hepatic encephalopathy and should be used as a second-line therapy after failure of medical management. The decision to use these endovascular therapies should be made in conjunction with hepatologists or gastroenterologists experienced in the management of portal hypertension.

Original languageEnglish (US)
Title of host publicationHaimovici's Vascular Surgery
Subtitle of host publication6th Edition
PublisherWiley-Blackwell
Pages1095-1106
Number of pages12
ISBN (Print)9781444330717
DOIs
Publication statusPublished - Oct 1 2012

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Keywords

  • Balloon-occluded retrograde transvenous obliteration (BRTO)
  • Budd-Chiari syndrome
  • Endovascular therapies
  • Hepatic encephalopathy
  • Hepatic hydrothorax
  • Portal hypertension
  • Portal hypertensive gastropathy (PHG)
  • Refractory acites
  • Transjugular intrahepatic portosystemic shunt (TIPS)
  • Variceal hemorrhage

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Golowa, Y., & Cynamon, J. (2012). Endovascular Treatment of Portal Hypertension. In Haimovici's Vascular Surgery: 6th Edition (pp. 1095-1106). Wiley-Blackwell. https://doi.org/10.1002/9781118481370.ch85