Indications n Contraindiations of TIPS

-
Indications


Accepted indications
Control of refractory acute variceal bleeding
Prevention of refractory recurrent variceal bleeding in Child class B and C patients
Refractory hepatic hydrothorax
Budd-Chiari syndrome
Refractory ascites

Promising but unproven
Hepatorenal syndrome
Veno-occlusive disease


Unproven
Prevention of refractory variceal bleeding in Child class A patients
Initial therapy of acute variceal hemorrhage
Initial therapy to prevent recurrent variceal hemorrhage
Prevention of initial variceal hemorrhage
Reduction in intraoperative morbidity rate during liver transplantation
Hepatopulmonary syndrome





Contraindications


Absolute contraindications
Right-sided heart failure
Primary pulmonary hypertension
Polycystic liver disease
Severe hepatic failure
Portal vein thrombosis with cavernous transformation


Relative contraindications
Biliary obstruction
Active intrahepatic or systemic infection
Severe hepatic encephalopathy poorly controlled by medical therapy
Portal vein thrombosis without cavernous transformation

Comments

Post a Comment

Popular posts from this blog

Esophageal Varices Treatment

-
Overview of the Principles and Techniques of the Major Treatment Modalities Endoscopic Therapy Endoscopy is the cornerstone of the management of gastrointestinal hemorrhage both as a diagnostic and as a therapeutic modality. Once esophageal varices are identified as the source or likely source of bleeding, endoscopic options for treatment include injection sclerotherapy and variceal band ligation. Although these techniques do not treat the underlying portal hypertension, they have been shown to be effective in controlling variceal hemorrhage. The rates of success and complications of these endoscopic techniques depend in part on the experience of the operator and the technique employed. Endoscopic Sclerotherapy A variety of techniques have been employed in performing endoscopic sclerotherapy (EST) with the goal of arresting acute bleeding and preventing recurrent bleeding through the obliteration of varices by repeated injections. Injections may be directed into the veins
Read more

Transjugular intrahepatic portosystemic shunts (TIPS)

-
Transjugular intrahepatic portosystemic shunts Only a few studies have reported on the effects of transjugular intrahepatic portosystemic shunts (TIPS) in patients with type 1 HRS. This procedure consists of insertion of an intrahepatic stent between the portal and hepatic veins by a transjugular approach. The main effect is to lower portal pressure. In type 1 HRS, TIPS improve circulatory function and reduce the activity of vasoconstrictor system.These effects are associated with a slow, moderate to strong increase in renal perfusion and GFR and a fall in serum creatinine concentrations in about 60% of patients. Median survival after TIPS in type 1 HRS is between 2 months and 4 months.As with vasoconstrictor drugs, the improved renal function probably, but not definitely, results in longer survival. Information currently available on the use of TIPS in type 1 HRS has been obtained in a very selected population of patients and may not be appli
Read more