Progress and prospect of TIPS for portal hypertension_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 MA Jun

Department of Interventional and Vascular Surgery, The People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, P. R. China;

Corresponding author：

MA Jun, Email: 454782980@qq.com

Keywords：

portal hypertension; esophagogastric variceal bleeding; transjugular intrahepatic portosystemic shunt; progress

DOI：

10.7507/1007-9424.202207009

Video：

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Transjugular intrahepatic portosystemic shunt (TIPS) has been used in the treatment of cirrhotic portal hypertension for more than 30 years. With the development of stent technology and clinical practice technology, TIPS is becoming more and more perfect in the treatment of portal hypertension. From the single-use of bare stent in the past to the application of bare stent combined with coated stent or particular Viatorr stent, the patency of stent has been significantly improved. In addition, the selection of stent caliber and the puncture part of shunt gradually reduces the occurrence of hepatic encephalopathy, liver failure and other complications caused by excessive shunt. TIPS technology has the advantages of minimally invasive, safe and reducing portal vein pressure. It has gradually become one of the primary surgical methods in the treatment of portal hypertension, esophagogastric variceal bleeding, intractable ascites, and so on.

Citation： MA Jun. Progress and prospect of TIPS for portal hypertension. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(8): 997-1000. doi: 10.7507/1007-9424.202207009 Copy

1.	马鹍鹏, 梁松年, 钟红珊, 等. Viatorr支架行TIPS术治疗门静脉高压性静脉曲张消化道出血效果评估. 介入放射学杂志, 2020, 29(4): 380-384.
2.	Richter GM, Nöldge G, Roeren T, et al. Historische und konzeptionelle Aspekte von TIPSS [Historical and conceptional aspects of TIPSS]. Radiologe, 1994, 34(4): 158-163.
3.	中国门静脉高压诊断与监测研究组(CHESS), 中华医学会消化病学分会微创介入协作组, 中国医师协会介入医师分会急诊介入专业委员会, 等. 中国肝静脉压力梯度临床应用专家共识 (2018版). 中华消化外科杂志, 2018, 17(11): 1059-1070.
4.	Ueda C, Yosizaki T, Katayama N, et al. Barrett’s adenocarcinoma with esophageal varices successfully treated by endoscopic submucosal dissection with direct varices coagulation. Clin J Gastroenterol, 2020, 13(2): 178-181.
5.	Wang YM, Li YH, Wu HM, et al. Portal vein thrombosis in patients with cirrhosis undergoing elective transjugular intrahepatic portosystemic shunt: risk factors, warfarin efficacy, and clinical outcomes. Clin Appl Thromb Hemost, 2018, 24(3): 462-470.
6.	李伟, 宋卫东, 谢巴图白音. 采用EVL或TIPS治疗肝硬化并发食管静脉曲张出血患者疗效及其预后分析. 实用肝脏病杂志, 2021, 24(5): 629-632.
7.	赵洪伟, 齐瑞兆, 岳振东, 等. 3 367例经颈静脉肝内门体分流术的技术难点分析. 中华消化外科杂志, 2016, 15(7): 689-695.
8.	Luo X, Wang Z, Tsauo J, et al. Advanced cirrhosis combined with portal vein thrombosis: A randomized trial of TIPS versus endoscopic band ligation plus propranolol for the prevention of recurrent esophageal variceal bleeding. Radiology, 2015, 276(1): 286-293.
9.	李莹, 练晶晶, 罗添成, 等. 预防肝硬化食管静脉曲张再出血的成本效果研究. 中华消化杂志, 2016, 36(2): 113-118.
10.	de Franchis R; Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno Ⅵ Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol, 2015, 63(3): 743-752.
11.	中国医师协会介入医师分会. 中国门静脉高压经颈静脉肝内门体分流术临床实践指南 (2019版). 中华医学杂志, 2019, 99(45): 3534-3546.
12.	中国医师协会急诊医师分会, 中华医学会急诊医学分会, 全军急救医学专业委员会, 等. 急性上消化道出血急诊诊治流程专家共识. 中国急救医学, 2021, 41(1): 1-10.
13.	Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology, 2017, 65(1): 310-335.
14.	Li S, Zhang C, Lin LL, et al. Early-TIPS versus current standard therapy for acute variceal bleeding in cirrhosis patients: A systemic review with meta-analysis. Front Pharmacol, 2020, 11: 603. doi: 10.3389/fphar.2020.00603.
15.	刘剑, 谢勇, 魏翠, 等. 早期经颈静脉肝内门体分流术治疗肝硬化急性静脉曲张破裂出血患者的meta分析. 介入放射学杂志, 2022, 31(1): 19-26.
16.	Violi F, Corazza GR, Caldwell SH, et al. Portal vein thrombosis relevance on liver cirrhosis: Italian Venous Thrombotic Events Registry. Intern Emerg Med, 2016, 11(8): 1059-1066.
17.	Khalili H, Goldman D, Frischhertz S, et al. Clinical images: transjugular intrahepatic portosystemic shunt reduction for management of recurrent hepatic encephalopathy. Ochsner J, 2017, 17(4): 311-316.
18.	Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology, 2014, 60(2): 715-735.
19.	褚建国, 孙晓丽, 朴龙松, 等. 门静脉左支分流降低术后肝性脑病的临床研究. 中华肝脏病杂志, 2002, 10(6): 437-440.
20.	Madoff DC, Wallace MJ. Reduced stents and stent-grafts for the management of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt creation. Semin Intervent Radiol, 2005, 22(4): 316-328.
21.	万里, 张文广, 任建庄, 等. 限流支架治疗经颈静脉肝内门体分流术后难治性肝性脑病效果和安全性分析. 介入放射学杂志, 2021, 30(7): 662-666.
22.	Kao SD, Morshedi MM, Narsinh KH, et al. Intravascular ultrasound in the creation of transhepatic portosystemic shunts reduces needle passes, radiation dose, and procedure time: A retrospective study of a single-institution experience. J Vasc Interv Radiol, 2016, 27(8): 1148-1153.
23.	Pillai AK, Andring B, Faulconer N, et al. Utility of intravascular US-guided portal vein access during transjugular intrahepatic portosystemic shunt creation: Retrospective comparison with conventional technique in 109 patients. J Vasc Interv Radiol, 2016, 27(8): 1154-1159.

1. 马鹍鹏, 梁松年, 钟红珊, 等. Viatorr支架行TIPS术治疗门静脉高压性静脉曲张消化道出血效果评估. 介入放射学杂志, 2020, 29(4): 380-384.
2. Richter GM, Nöldge G, Roeren T, et al. Historische und konzeptionelle Aspekte von TIPSS [Historical and conceptional aspects of TIPSS]. Radiologe, 1994, 34(4): 158-163.
3. 中国门静脉高压诊断与监测研究组(CHESS), 中华医学会消化病学分会微创介入协作组, 中国医师协会介入医师分会急诊介入专业委员会, 等. 中国肝静脉压力梯度临床应用专家共识 (2018版). 中华消化外科杂志, 2018, 17(11): 1059-1070.
4. Ueda C, Yosizaki T, Katayama N, et al. Barrett’s adenocarcinoma with esophageal varices successfully treated by endoscopic submucosal dissection with direct varices coagulation. Clin J Gastroenterol, 2020, 13(2): 178-181.
5. Wang YM, Li YH, Wu HM, et al. Portal vein thrombosis in patients with cirrhosis undergoing elective transjugular intrahepatic portosystemic shunt: risk factors, warfarin efficacy, and clinical outcomes. Clin Appl Thromb Hemost, 2018, 24(3): 462-470.
6. 李伟, 宋卫东, 谢巴图白音. 采用EVL或TIPS治疗肝硬化并发食管静脉曲张出血患者疗效及其预后分析. 实用肝脏病杂志, 2021, 24(5): 629-632.
7. 赵洪伟, 齐瑞兆, 岳振东, 等. 3 367例经颈静脉肝内门体分流术的技术难点分析. 中华消化外科杂志, 2016, 15(7): 689-695.
8. Luo X, Wang Z, Tsauo J, et al. Advanced cirrhosis combined with portal vein thrombosis: A randomized trial of TIPS versus endoscopic band ligation plus propranolol for the prevention of recurrent esophageal variceal bleeding. Radiology, 2015, 276(1): 286-293.
9. 李莹, 练晶晶, 罗添成, 等. 预防肝硬化食管静脉曲张再出血的成本效果研究. 中华消化杂志, 2016, 36(2): 113-118.
10. de Franchis R; Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno Ⅵ Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol, 2015, 63(3): 743-752.
11. 中国医师协会介入医师分会. 中国门静脉高压经颈静脉肝内门体分流术临床实践指南 (2019版). 中华医学杂志, 2019, 99(45): 3534-3546.
12. 中国医师协会急诊医师分会, 中华医学会急诊医学分会, 全军急救医学专业委员会, 等. 急性上消化道出血急诊诊治流程专家共识. 中国急救医学, 2021, 41(1): 1-10.
13. Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology, 2017, 65(1): 310-335.
14. Li S, Zhang C, Lin LL, et al. Early-TIPS versus current standard therapy for acute variceal bleeding in cirrhosis patients: A systemic review with meta-analysis. Front Pharmacol, 2020, 11: 603. doi: 10.3389/fphar.2020.00603.
15. 刘剑, 谢勇, 魏翠, 等. 早期经颈静脉肝内门体分流术治疗肝硬化急性静脉曲张破裂出血患者的meta分析. 介入放射学杂志, 2022, 31(1): 19-26.
16. Violi F, Corazza GR, Caldwell SH, et al. Portal vein thrombosis relevance on liver cirrhosis: Italian Venous Thrombotic Events Registry. Intern Emerg Med, 2016, 11(8): 1059-1066.
17. Khalili H, Goldman D, Frischhertz S, et al. Clinical images: transjugular intrahepatic portosystemic shunt reduction for management of recurrent hepatic encephalopathy. Ochsner J, 2017, 17(4): 311-316.
18. Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology, 2014, 60(2): 715-735.
19. 褚建国, 孙晓丽, 朴龙松, 等. 门静脉左支分流降低术后肝性脑病的临床研究. 中华肝脏病杂志, 2002, 10(6): 437-440.
20. Madoff DC, Wallace MJ. Reduced stents and stent-grafts for the management of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt creation. Semin Intervent Radiol, 2005, 22(4): 316-328.
21. 万里, 张文广, 任建庄, 等. 限流支架治疗经颈静脉肝内门体分流术后难治性肝性脑病效果和安全性分析. 介入放射学杂志, 2021, 30(7): 662-666.
22. Kao SD, Morshedi MM, Narsinh KH, et al. Intravascular ultrasound in the creation of transhepatic portosystemic shunts reduces needle passes, radiation dose, and procedure time: A retrospective study of a single-institution experience. J Vasc Interv Radiol, 2016, 27(8): 1148-1153.
23. Pillai AK, Andring B, Faulconer N, et al. Utility of intravascular US-guided portal vein access during transjugular intrahepatic portosystemic shunt creation: Retrospective comparison with conventional technique in 109 patients. J Vasc Interv Radiol, 2016, 27(8): 1154-1159.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Progress and prospect of TIPS for portal hypertension

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