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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(04): 917-932
DOI: 10.1055/s-0041-1740235
Review Article

Indian College of Radiology and Imaging Evidence-Based Guidelines for Interventions in Portal Hypertension and Its Complications

Amar Mukund 
1   Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
,
Shaleen Rana
1   Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
,
Chander Mohan
2   Department of Interventional Radiology, BLK Superspecialty Hospital, New Delhi, India
,
Naveen Kalra 
3   Department of Radiology, PGIMER, Chandigarh, India
,
Sanjay Saran Baijal
4   Department of Diagnostic and Interventional Radiology, Medanta—The Medicity, Gurugram, Haryana, India
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Abstract

Portal hypertension is a complication of chronic liver disease. Various radiological interventions are being done to aid in the diagnosis of portal hypertension; further, an interventional radiologist can offer various treatments for the complications of portal hypertension. Diagnosis of portal hypertension in its early stage may require hepatic venous pressure gradient measurement. Measurement of gradient also guides in diagnosing the type of portal hypertension, measuring response to treatment and prognostication. This article attempts to provide evidence-based guidelines on the management of portal hypertension and treatment of its complications.

Keywords

balloon-occluded retrograde transvenous obliteration - hepatic venous pressure gradient - portal hypertension - transjugular intrahepatic portosystemic shunt - transjugular liver biopsy

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.


IRB Statement

Being a review article, it does not require institutional review board approval.


Financial Support and Sponsorship

None.




Publication History

Article published online:
10 January 2022

© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Al-Busafi SA, McNabb-Baltar J, Farag A, Hilzenrat N. Clinical manifestations of portal hypertension. Int J Hepatol 2012; 2012: 203794
    PubMedGoogle Scholar
  • 2 de Franchis R, Primignani M. Natural history of portal hypertension in patients with cirrhosis. Clin Liver Dis 2001; 5 (03) 645-663
    CrossrefPubMedGoogle Scholar
  • 3 Leung JC, Loong TC, Pang J, Wei JL, Wong VW. Invasive and non-invasive assessment of portal hypertension. Hepatol Int 2018; 12 (Suppl. 01) 44-55
    CrossrefPubMedGoogle Scholar
  • 4 de Bruyn G, Graviss EA. A systematic review of the diagnostic accuracy of physical examination for the detection of cirrhosis. BMC Med Inform Decis Mak 2001; 1: 6
    CrossrefPubMedGoogle Scholar
  • 5 Christensen E, Schlichting P, Fauerholdt L. et al. Prognostic value of Child-Turcotte criteria in medically treated cirrhosis. Hepatology 1984; 4 (03) 430-435
    CrossrefPubMedGoogle Scholar
  • 6 Northup PG, Wanamaker RC, Lee VD, Adams RB, Berg CL. Model for End-Stage Liver Disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis. Ann Surg 2005; 242 (02) 244-251
    CrossrefPubMedGoogle Scholar
  • 7 Berzigotti A, Piscaglia F. Ultrasound in portal hypertension—part 1. Ultraschall Med 2011; 32 (06) 548-568 , quiz 569–571
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Berzigotti A, Piscaglia F. EFSUMB Education and Professional Standards Committee. Ultrasound in portal hypertension—part 2—–and EFSUMB recommendations for the performance and reporting of ultrasound examinations in portal hypertension. Ultraschall Med 2012; 33 (01) 8-32 , quiz 30–31
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Sangster GP, Previgliano CH, Nader M, Chwoschtschinsky E, Heldmann MG. MDCT imaging findings of liver cirrhosis: spectrum of hepatic and extrahepatic abdominal complications. HPB Surg 2013; 2013: 129396
    CrossrefPubMedGoogle Scholar
  • 10 Kang HK, Jeong YY, Choi JH. et al. Three-dimensional multi-detector row CT portal venography in the evaluation of portosystemic collateral vessels in liver cirrhosis. Radiographics 2002; 22 (05) 1053-1061
    CrossrefPubMedGoogle Scholar
  • 11 Al-Osaimi AM, Sabri SS, Caldwell SH. Balloon-occluded Retrograde Transvenous Obliteration (BRTO): preprocedural evaluation and imaging. Semin Intervent Radiol 2011; 28 (03) 288-295
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Singh S, Venkatesh SK, Wang Z. et al. Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data. Clin Gastroenterol Hepatol 2015; 13 (03) 440-451.e6
    CrossrefPubMedGoogle Scholar
  • 13 Talwalkar JA, Yin M, Venkatesh S. et al. Feasibility of in vivo MR elastographic splenic stiffness measurements in the assessment of portal hypertension. AJR Am J Roentgenol 2009; 193 (01) 122-127
    CrossrefPubMedGoogle Scholar
  • 14 European Association for Study of Liver, Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015; 63 (01) 237-264
    CrossrefPubMedGoogle Scholar
  • 15 Chou R, Wasson N. Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review. Ann Intern Med 2013; 158 (11) 807-820
    CrossrefPubMedGoogle Scholar
  • 16 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 (03) 743-752
    CrossrefPubMedGoogle Scholar
  • 17 Millonig G, Friedrich S, Adolf S. et al. Liver stiffness is directly influenced by central venous pressure. J Hepatol 2010; 52 (02) 206-210
    CrossrefPubMedGoogle Scholar
  • 18 Bosch J, Abraldes JG, Berzigotti A, García-Pagan JC. The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol 2009; 6 (10) 573-582
    CrossrefPubMedGoogle Scholar
  • 19 Feu F, García-Pagán JC, Bosch J. et al. Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis. Lancet 1995; 346 (8982): 1056-1059
    CrossrefPubMedGoogle Scholar
  • 20 Turnes J, Garcia-Pagan JC, Abraldes JG, Hernandez-Guerra M, Dell'Era A, Bosch J. Pharmacological reduction of portal pressure and long-term risk of first variceal bleeding in patients with cirrhosis. Am J Gastroenterol 2006; 101 (03) 506-512
    CrossrefPubMedGoogle Scholar
  • 21 Kim MY, Baik SK, Yea CJ. et al. Hepatic venous pressure gradient can predict the development of hepatocellular carcinoma and hyponatremia in decompensated alcoholic cirrhosis. Eur J Gastroenterol Hepatol 2009; 21 (11) 1241-1246
    CrossrefPubMedGoogle Scholar
  • 22 Ripoll C, Groszmann RJ, Garcia-Tsao G. et al; Portal Hypertension Collaborative Group. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol 2009; 50 (05) 923-928
    CrossrefPubMedGoogle Scholar
  • 23 Merkel C, Bolognesi M, Sacerdoti D. et al. The hemodynamic response to medical treatment of portal hypertension as a predictor of clinical effectiveness in the primary prophylaxis of variceal bleeding in cirrhosis. Hepatology 2000; 32 (05) 930-934
    CrossrefPubMedGoogle Scholar
  • 24 Stanley AJ, Robinson I, Forrest EH, Jones AL, Hayes PC. Haemodynamic parameters predicting variceal haemorrhage and survival in alcoholic cirrhosis. QJM 1998; 91 (01) 19-25
    CrossrefPubMedGoogle Scholar
  • 25 Bañares R, Moitinho E, Matilla A. et al. Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis. Hepatology 2002; 36 (06) 1367-1373
    CrossrefPubMedGoogle Scholar
  • 26 Abraldes JG, Albillos A, Bañares R. et al. Simvastatin lowers portal pressure in patients with cirrhosis and portal hypertension: a randomized controlled trial. Gastroenterology 2009; 136 (05) 1651-1658
    CrossrefPubMedGoogle Scholar
  • 27 Kumar A, Sharma P, Sarin SK. Hepatic venous pressure gradient measurement: time to learn!. Indian J Gastroenterol 2008; 27 (02) 74-80
    PubMedGoogle Scholar
  • 28 Philips C. In pictures: hepatic venous pressure gradient-indications, technique and complications. Int J Anat Radiol Surg 2017; 6: RR01-RR04
    Google Scholar
  • 29 Chelliah ST, Keshava SN, Moses V, Surendrababu NR, Zachariah UG, Eapen C. Measurement of hepatic venous pressure gradient revisited: catheter wedge vs balloon wedge techniques. Indian J Radiol Imaging 2011; 21 (04) 291-293
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Suk KT. Hepatic venous pressure gradient: clinical use in chronic liver disease. Clin Mol Hepatol 2014; 20 (01) 6-14
    CrossrefPubMedGoogle Scholar
  • 31 Practice Guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology 2017; 126 (03) 376-393
    CrossrefPubMedGoogle Scholar
  • 32 Patel IJ, Rahim S, Davidson JC. et al. Society of Interventional Radiology Consensus Guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions-part II: recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30 (08) 1168-1184.e1
    CrossrefPubMedGoogle Scholar
  • 33 Tey TT, Gogna A, Irani FG. et al. Application of a standardised protocol for hepatic venous pressure gradient measurement improves quality of readings and facilitates reduction of variceal bleeding in cirrhotics. Singapore Med J 2016; 57 (03) 132-137
    CrossrefPubMedGoogle Scholar
  • 34 Wallace MJ, Narvios A, Lichtiger B. et al. Transjugular liver biopsy in patients with hematologic malignancy and severe thrombocytopenia. J Vasc Interv Radiol 2003; 14 (03) 323-327
    CrossrefPubMedGoogle Scholar
  • 35 Mohanty D. Current concepts in platelet transfusion. Asian J Transfus Sci 2009; 3 (01) 18-21
    CrossrefPubMedGoogle Scholar
  • 36 Dohan A, Guerrache Y, Boudiaf M, Gavini JP, Kaci R, Soyer P. Transjugular liver biopsy: indications, technique and results. Diagn Interv Imaging 2014; 95 (01) 11-15
    CrossrefPubMedGoogle Scholar
  • 37 Mammen T, Keshava SN, Eapen CE. et al. Transjugular liver biopsy: a retrospective analysis of 601 cases. J Vasc Interv Radiol 2008; 19 (03) 351-358
    CrossrefPubMedGoogle Scholar
  • 38 Sebastian B, Singhal S, Botcha S, Madhurkar R, Thiruchunapalli D, Uthappa MC. The utility of ultrasound guidance in transjugular liver biopsy: our experience. Abdom Radiol (NY) 2019; 44 (02) 749-755
    CrossrefPubMedGoogle Scholar
  • 39 Cynamon J, Shabrang C, Golowa Y, Daftari A, Herman O, Jagust M. Transfemoral transcaval core-needle liver biopsy: an alternative to transjugular liver biopsy. J Vasc Interv Radiol 2016; 27 (03) 370-375
    CrossrefPubMedGoogle Scholar
  • 40 Li FQ, Ko GY, Sung KB. et al. Transfemoral liver biopsy using a Quick-Core biopsy needle system in living donor liver transplantation recipients. Liver Transpl 2014; 20 (10) 1178-1184
    CrossrefPubMedGoogle Scholar
  • 41 Yavuz K, Geyik S, Barton RE. et al. Transjugular liver biopsy via the left internal jugular vein. J Vasc Interv Radiol 2007; 18 (02) 237-241
    CrossrefPubMedGoogle Scholar
  • 42 Siegel EL, Caresio J, Eckard DA. Use of the external jugular vein approach for transvenous liver biopsy. J Vasc Interv Radiol 1992; 3 (02) 371-374
    CrossrefPubMedGoogle Scholar
  • 43 Patel A, Gogna A, Irani FG. et al. Single centre experience of transjugular liver biopsy in 152 patients. Ann Acad Med Singap 2014; 43 (03) 160-165
    CrossrefPubMedGoogle Scholar
  • 44 Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001; 344 (07) 495-500
    CrossrefPubMedGoogle Scholar
  • 45 Kim KR, Ko GY, Sung KB. et al. Transjugular liver biopsy in patients with living donor liver transplantation: comparison with percutaneous biopsy. Liver Transpl 2008; 14 (07) 971-979
    CrossrefPubMedGoogle Scholar
  • 46 Behrens G, Ferral H. Transjugular liver biopsy. Semin Intervent Radiol 2012; 29 (02) 111-117
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Neumayr A, Troia G, de Bernardis C. et al. Justified concern or exaggerated fear: the risk of anaphylaxis in percutaneous treatment of cystic echinococcosis-a systematic literature review. PLoS Negl Trop Dis 2011; 5 (06) e1154
    CrossrefPubMedGoogle Scholar
  • 48 Colloredo G, Guido M, Sonzogni A, Leandro G. Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. J Hepatol 2003; 39 (02) 239-244
    CrossrefPubMedGoogle Scholar
  • 49 Cholongitas E, Quaglia A, Samonakis D. et al. Transjugular liver biopsy: how good is it for accurate histological interpretation?. Gut 2006; 55 (12) 1789-1794
    CrossrefPubMedGoogle Scholar
  • 50 Kalambokis G, Manousou P, Vibhakorn S. et al. Transjugular liver biopsy—indications, adequacy, quality of specimens, and complications—a systematic review. J Hepatol 2007; 47 (02) 284-294
    CrossrefPubMedGoogle Scholar
  • 51 Jana M, Gamanagatti S. Transjugular liver biopsy: tips and tricks. Trop Gastroenterol 2012; 33 (03) 168-172
    PubMedGoogle Scholar
  • 52 Dohan A, Guerrache Y, Dautry R. et al. Major complications due to transjugular liver biopsy: incidence, management and outcome. Diagn Interv Imaging 2015; 96 (06) 571-577
    CrossrefPubMedGoogle Scholar
  • 53 Moore KP, Aithal GP. Guidelines on the management of ascites in cirrhosis. Gut 2006; 55 (Suppl. 06) vi1-vi12
    PubMedGoogle Scholar
  • 54 Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med 1992; 117 (03) 215-220
    CrossrefPubMedGoogle Scholar
  • 55 Runyon BA. AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49 (06) 2087-2107
    CrossrefPubMedGoogle Scholar
  • 56 Rimola A, García-Tsao G, Navasa M. et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol 2000; 32 (01) 142-153
    CrossrefPubMedGoogle Scholar
  • 57 Santos J, Planas R, Pardo A. et al. Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis. A randomized comparative study of efficacy and safety. J Hepatol 2003; 39 (02) 187-192
    CrossrefPubMedGoogle Scholar
  • 58 European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53 (03) 397-417
    CrossrefPubMedGoogle Scholar
  • 59 Solà R, Vila MC, Andreu M. et al. Total paracentesis with dextran 40 vs diuretics in the treatment of ascites in cirrhosis: a randomized controlled study. J Hepatol 1994; 20 (02) 282-288
    CrossrefPubMedGoogle Scholar
  • 60 Fernández-Esparrach G, Guevara M, Sort P. et al. Diuretic requirements after therapeutic paracentesis in non-azotemic patients with cirrhosis. A randomized double-blind trial of spironolactone versus placebo. J Hepatol 1997; 26 (03) 614-620
    CrossrefPubMedGoogle Scholar
  • 61 Rössle M, Ochs A, Gülberg V. et al. A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N Engl J Med 2000; 342 (23) 1701-1707
    CrossrefPubMedGoogle Scholar
  • 62 Ginès P, Uriz J, Calahorra B. et al. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. Gastroenterology 2002; 123 (06) 1839-1847
    CrossrefPubMedGoogle Scholar
  • 63 Deltenre P, Mathurin P, Dharancy S. et al. Transjugular intrahepatic portosystemic shunt in refractory ascites: a meta-analysis. Liver Int 2005; 25 (02) 349-356
    CrossrefPubMedGoogle Scholar
  • 64 Albillos A, Bañares R, González M, Catalina MV, Molinero LM. A meta-analysis of transjugular intrahepatic portosystemic shunt versus paracentesis for refractory ascites. J Hepatol 2005; 43 (06) 990-996
    CrossrefPubMedGoogle Scholar
  • 65 Saab S, Nieto JM, Lewis SK, Runyon BA. TIPS versus paracentesis for cirrhotic patients with refractory ascites. Cochrane Database Syst Rev 2006; CD004889 (04) CD004889
    Google Scholar
  • 66 Salerno F, Cammà C, Enea M, Rössle M, Wong F. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology 2007; 133 (03) 825-834
    CrossrefPubMedGoogle Scholar
  • 67 Stanley MM, Ochi S, Lee KK. et al; Veterans Administration Cooperative Study on Treatment of Alcoholic Cirrhosis with Ascites. Peritoneovenous shunting as compared with medical treatment in patients with alcoholic cirrhosis and massive ascites. N Engl J Med 1989; 321 (24) 1632-1638
    CrossrefPubMedGoogle Scholar
  • 68 Ginès P, Arroyo V, Vargas V. et al. Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites. N Engl J Med 1991; 325 (12) 829-835
    CrossrefPubMedGoogle Scholar
  • 69 Corrigan M, Thomas R, McDonagh J. et al. Tunnelled peritoneal drainage catheter placement for the palliative management of refractory ascites in patients with liver cirrhosis. Frontline Gastroenterol 2020; 12 (02) 108-112
    CrossrefPubMedGoogle Scholar
  • 70 Reinglas J, Amjadi K, Petrcich B, Momoli F, Shaw-Stiffel T. The palliative management of refractory cirrhotic ascites using the PleurX (©) catheter. Can J Gastroenterol Hepatol 2016; 2016: 4680543
    CrossrefPubMedGoogle Scholar
  • 71 Avgerinos A, Nevens F, Raptis S, Fevery J. Early administration of somatostatin and efficacy of sclerotherapy in acute oesophageal variceal bleeds: the European Acute Bleeding Oesophageal Variceal Episodes (ABOVE) randomised trial. Lancet 1997; 350 (9090): 1495-1499
    CrossrefPubMedGoogle Scholar
  • 72 Vangeli M, Patch D, Burroughs AK. Salvage tips for uncontrolled variceal bleeding. J Hepatol 2002; 37 (05) 703-704
    CrossrefPubMedGoogle Scholar
  • 73 Azoulay D, Castaing D, Majno P. et al. Salvage transjugular intrahepatic portosystemic shunt for uncontrolled variceal bleeding in patients with decompensated cirrhosis. J Hepatol 2001; 35 (05) 590-597
    CrossrefPubMedGoogle Scholar
  • 74 Maimone S, Saffioti F, Filomia R. et al. Predictors of re-bleeding and mortality among patients with refractory variceal bleeding undergoing salvage Transjugular Intrahepatic Portosystemic Shunt (TIPS). Dig Dis Sci 2019; 64 (05) 1335-1345
    CrossrefPubMedGoogle Scholar
  • 75 Monescillo A, Martínez-Lagares F, Ruiz-del-Arbol L. et al. Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding. Hepatology 2004; 40 (04) 793-801
    CrossrefPubMedGoogle Scholar
  • 76 García-Pagán JC, Caca K, Bureau C. et al; Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010; 362 (25) 2370-2379
    CrossrefPubMedGoogle Scholar
  • 77 Garcia-Pagán JC, Di Pascoli M, Caca K. et al. Use of early-TIPS for high-risk variceal bleeding: results of a post-RCT surveillance study. J Hepatol 2013; 58 (01) 45-50
    CrossrefPubMedGoogle Scholar
  • 78 Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases. The role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the management of portal hypertension: update 2009. Hepatology 2010; 51 (01) 306
    CrossrefPubMedGoogle Scholar
  • 79 Jalan R, Bzeizi KI, Tripathi D, Lui HF, Redhead DN, Hayes PC. Impact of transjugular intrahepatic portosystemic stent-shunt for secondary prophylaxis of oesophageal variceal haemorrhage: a single-centre study over an 11-year period. Eur J Gastroenterol Hepatol 2002; 14 (06) 615-626
    CrossrefPubMedGoogle Scholar
  • 80 Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. 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 (01) 310-335
    CrossrefPubMedGoogle Scholar
  • 81 Chau TN, Patch D, Chan YW, Nagral A, Dick R, Burroughs AK. “Salvage” transjugular intrahepatic portosystemic shunts: gastric fundal compared with esophageal variceal bleeding. Gastroenterology 1998; 114 (05) 981-987
    CrossrefPubMedGoogle Scholar
  • 82 Kochhar GS, Navaneethan U, Hartman J. et al. Comparative study of endoscopy vs. transjugular intrahepatic portosystemic shunt in the management of gastric variceal bleeding. Gastroenterol Rep (Oxf) 2015; 3 (01) 75-82
    CrossrefPubMedGoogle Scholar
  • 83 Lo GH, Liang HL, Chen WC. et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy 2007; 39 (08) 679-685
    Article in Thieme ConnectPubMedGoogle Scholar
  • 84 Yu J, Wang X, Jiang M. et al. Comparison of transjugular intrahepatic portosystemic shunt (TIPS) alone and combined with embolisation for the management of cardiofundal varices: a retrospective study. Eur Radiol 2019; 29 (02) 699-706
    CrossrefPubMedGoogle Scholar
  • 85 Park JK, Saab S, Kee ST. et al. Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for treatment of gastric varices: review and meta-analysis. Dig Dis Sci 2015; 60 (06) 1543-1553
    CrossrefPubMedGoogle Scholar
  • 86 Mukund A, Deogaonkar G, Rajesh S, Shasthry SM, Sarin SK. Safety and efficacy of sodium tetradecyl sulfate and lipiodol foam in Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for large porto-systemic shunts. Cardiovasc Intervent Radiol 2017; 40 (07) 1010-1016
    CrossrefPubMedGoogle Scholar
  • 87 Paleti S, Nutalapati V, Fathallah J, Jeepalyam S, Rustagi T. Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) versus Transjugular Intrahepatic Portosystemic Shunt (TIPS) for treatment of gastric varices because of portal hypertension: a systematic review and meta-analysis. J Clin Gastroenterol 2020; 54 (07) 655-660
    CrossrefPubMedGoogle Scholar
  • 88 Mukund A, Rangarh P, Shasthry SM, Patidar Y, Sarin SK. Salvage balloon occluded retrograde transvenous obliteration for gastric variceal bleed in cirrhotic patients with endoscopic failure to control bleed/very early rebleed: long-term outcomes. J Clin Exp Hepatol 2020; 10 (05) 421-428
    CrossrefPubMedGoogle Scholar
  • 89 Morrison JD, Mendoza-Elias N, Lipnik AJ. et al. Gastric varices bleed at lower portosystemic pressure gradients than esophageal varices. J Vasc Interv Radiol 2018; 29 (05) 636-641
    CrossrefPubMedGoogle Scholar
  • 90 Saad WE, Darcy MD. Transjugular Intrahepatic Portosystemic Shunt (TIPS) versus Balloon-occluded Retrograde Transvenous Obliteration (BRTO) for the Management of Gastric Varices. Semin Intervent Radiol 2011; 28 (03) 339-349
    Article in Thieme ConnectPubMedGoogle Scholar
  • 91 Mukund A, Rajesh S, Arora A, Patidar Y, Jain D, Sarin SK. Efficacy of balloon-occluded retrograde transvenous obliteration of large spontaneous lienorenal shunt in patients with severe recurrent hepatic encephalopathy with foam sclerotherapy: initial experience. J Vasc Interv Radiol 2012; 23 (09) 1200-1206
    CrossrefPubMedGoogle Scholar
  • 92 Mukund A, Chalamarla LK, Singla N, Shasthry SM, Sarin SK. Intractable hepatic encephalopathy in cirrhotic patients: mid-term efficacy of balloon-occluded retrograde portosystemic shunt obliteration. Eur Radiol 2020; 30 (06) 3462-3472
    CrossrefPubMedGoogle Scholar
  • 93 Garbuzenko DV, Arefyev NO. Hepatic hydrothorax: an update and review of the literature. World J Hepatol 2017; 9 (31) 1197-1204
    CrossrefPubMedGoogle Scholar
  • 94 Barreales M, Sáenz-López S, Igarzabal A. et al. Refractory hepatic hydrothorax: successful treatment with octreotide. Rev Esp Enferm Dig 2005; 97 (11) 830-835
    CrossrefPubMedGoogle Scholar
  • 95 Ibrisim D, Cakaloglu Y, Akyuz F. et al. Treatment of hepatic hydrothorax with terlipressin in a cirrhotic patient. Scand J Gastroenterol 2006; 41 (07) 862-865
    CrossrefPubMedGoogle Scholar
  • 96 Haas KP, Chen AC. Indwelling tunneled pleural catheters for the management of hepatic hydrothorax. Curr Opin Pulm Med 2017; 23 (04) 351-356
    CrossrefPubMedGoogle Scholar
  • 97 Hou F, Qi X, Guo X. Effectiveness and safety of pleurodesis for hepatic hydrothorax: a systematic review and meta-analysis. Dig Dis Sci 2016; 61 (11) 3321-3334
    CrossrefPubMedGoogle Scholar
  • 98 Gordon FD, Anastopoulos HT, Crenshaw W. et al. The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt. Hepatology 1997; 25 (06) 1366-1369
    CrossrefPubMedGoogle Scholar
  • 99 European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018; 69: 406-460
    CrossrefPubMedGoogle Scholar
  • 100 Guevara M, Ginès P, Bandi JC. et al. Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: effects on renal function and vasoactive systems. Hepatology 1998; 28 (02) 416-422
    CrossrefPubMedGoogle Scholar
  • 101 Testino G, Ferro C, Sumberaz A. et al. Type-2 hepatorenal syndrome and refractory ascites: role of transjugular intrahepatic portosystemic stent-shunt in eighteen patients with advanced cirrhosis awaiting orthotopic liver transplantation. Hepatogastroenterology 2003; 50 (54) 1753-1755
    PubMedGoogle Scholar
  • 102 Janssen HL, Garcia-Pagan JC, Elias E, Mentha G, Hadengue A, Valla DC. European Group for the Study of Vascular Disorders of the Liver. Budd-Chiari syndrome: a review by an expert panel. J Hepatol 2003; 38 (03) 364-371
    CrossrefPubMedGoogle Scholar
  • 103 Mukund A, Sarin SK. Budd-Chiari syndrome: a focussed and collaborative approach. Hepatol Int 2018; 12 (06) 483-486
    CrossrefPubMedGoogle Scholar
  • 104 Mukund A, Gamanagatti S. Imaging and interventions in Budd-Chiari syndrome. World J Radiol 2011; 3 (07) 169-177
    CrossrefPubMedGoogle Scholar
  • 105 Mukund A, Gamanagatti S, Acharya SK. Radiological interventions in HVOTO—practical tips. Trop Gastroenterol 2011; 32 (01) 4-14
    PubMedGoogle Scholar
  • 106 European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu. EASL Clinical Practice Guidelines: vascular diseases of the liver. J Hepatol 2016; 64: 179-202
    CrossrefPubMedGoogle Scholar
  • 107 Mukund A, Pargewar SS, Desai SN, Rajesh S, Sarin SK. Changes in liver congestion in patients with Budd-Chiari syndrome following endovascular interventions: assessment with transient elastography. J Vasc Interv Radiol 2017; 28 (05) 683-687
    CrossrefPubMedGoogle Scholar
  • 108 Garcia-Pagán JC, Heydtmann M, Raffa S. et al; Budd-Chiari Syndrome-Transjugular Intrahepatic Portosystemic Shunt Group. TIPS for Budd-Chiari syndrome: long-term results and prognostics factors in 124 patients. Gastroenterology 2008; 135 (03) 808-815
    CrossrefPubMedGoogle Scholar
  • 109 Mukund A, Mittal K, Mondal A, Sarin SK. Anatomic recanalization of hepatic vein and inferior vena cava versus direct intrahepatic portosystemic shunt creation in Budd-Chiari syndrome: overall outcome and midterm transplant-free survival. J Vasc Interv Radiol 2018; 29 (06) 790-799
    CrossrefPubMedGoogle Scholar
  • 110 Haskal ZJ, Martin L, Cardella JF. et al; Society of Cardiovascular & Interventional Radiology, Standards of Practice Committee, SCVIR Standards of Practice Committee. Quality improvement guidelines for transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol 2001; 12 (02) 131-136
    CrossrefPubMedGoogle Scholar
  • 111 Hung ML, Lee EW. Role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension: review and update of the literature. Clin Liver Dis 2019; 23 (04) 737-754
    CrossrefPubMedGoogle Scholar
  • 112 Parker R. Role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Clin Liver Dis 2014; 18 (02) 319-334
    CrossrefPubMedGoogle Scholar
  • 113 Harikrishnan KM. Transjugular intrahepatic portosystemic stent shunt. Med J Armed Forces India 1995; 51 (04) 281-283
    CrossrefPubMedGoogle Scholar
  • 114 Chalasani N, Clark WS, Martin LG. et al. Determinants of mortality in patients with advanced cirrhosis after transjugular intrahepatic portosystemic shunting. Gastroenterology 2000; 118 (01) 138-144
    CrossrefPubMedGoogle Scholar
  • 115 Salerno F, Merli M, Cazzaniga M. et al. MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol 2002; 36 (04) 494-500
    CrossrefPubMedGoogle Scholar
  • 116 Krajina A, Hulek P, Fejfar T, Valek V. Quality improvement guidelines for Transjugular Intrahepatic Portosystemic Shunt (TIPS). Cardiovasc Intervent Radiol 2012; 35 (06) 1295-1300
    CrossrefPubMedGoogle Scholar
  • 117 Miraglia R, Maruzzelli L, Cortis K. et al. Radiation exposure in transjugular intrahepatic portosystemic shunt creation. Cardiovasc Intervent Radiol 2016; 39 (02) 210-217
    CrossrefPubMedGoogle Scholar
  • 118 Miraglia R, Gerasia R, Maruzzelli L, D'Amico M, Luca A. Radiation doses to operators performing transjugular intrahepatic portosystemic shunt using a flat-panel detector-based system and ultrasound guidance for portal vein targeting. Eur Radiol 2017; 27 (05) 1783-1786
    CrossrefPubMedGoogle Scholar
  • 119 Tavare AN, Wigham A, Hadjivassilou A. et al. Use of transabdominal ultrasound-guided transjugular portal vein puncture on radiation dose in transjugular intrahepatic portosystemic shunt formation. Diagn Interv Radiol 2017; 23 (03) 206-210
    CrossrefPubMedGoogle Scholar
  • 120 Petersen B. Intravascular ultrasound-guided direct intrahepatic portacaval shunt: description of technique and technical refinements. J Vasc Interv Radiol 2003; 14 (01) 21-32
    PubMedGoogle Scholar
  • 121 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 (08) 1154-1159
    CrossrefPubMedGoogle Scholar
  • 122 Triantafyllou T, Aggarwal P, Gupta E, Svetanoff WJ, Bhirud DP, Singhal S. Polytetrafluoroethylene-covered stent graft versus bare stent in transjugular intrahepatic portosystemic shunt: systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A 2018; 28 (07) 867-879
    CrossrefPubMedGoogle Scholar
  • 123 LaBerge JM, Ferrell LD, Ring EJ, Gordon RL. Histopathologic study of stenotic and occluded transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol 1993; 4 (06) 779-786
    CrossrefPubMedGoogle Scholar
  • 124 Barrio J, Ripoll C, Bañares R. et al. Comparison of transjugular intrahepatic portosystemic shunt dysfunction in PTFE-covered stent-grafts versus bare stents. Eur J Radiol 2005; 55 (01) 120-124
    CrossrefPubMedGoogle Scholar
  • 125 Bercu ZL, Fischman AM, Kim E. et al. TIPS for refractory ascites: a 6-year single-center experience with expanded polytetrafluoroethylene-covered stent-grafts. AJR Am J Roentgenol 2015; 204 (03) 654-661
    CrossrefPubMedGoogle Scholar
  • 126 Amarapurkar DN, Punamiya S, Patel ND. An experience with covered transjugular intrahepatic portosystemic shunt for refractory ascites from western India. Ann Hepatol 2006; 5 (02) 103-108
    CrossrefPubMedGoogle Scholar
  • 127 Casado M, Bosch J, García-Pagán JC. et al. Clinical events after transjugular intrahepatic portosystemic shunt: correlation with hemodynamic findings. Gastroenterology 1998; 114 (06) 1296-1303
    CrossrefPubMedGoogle Scholar
  • 128 Anuradha Rao TN, Rastogi H, Pandey UC. Pictorial essay: trans-jugular intra-hepatic porto-systemic shunt (TIPS). Indian J Radiol Imaging 2001; 11: 17-22
    Google Scholar
  • 129 Qi X, Liu L, Bai M. et al. Transjugular intrahepatic portosystemic shunt in combination with or without variceal embolization for the prevention of variceal rebleeding: a meta-analysis. J Gastroenterol Hepatol 2014; 29 (04) 688-696
    CrossrefPubMedGoogle Scholar
  • 130 Valentin N, Korrapati P, Constantino J, Young A, Weisberg I. The role of transjugular intrahepatic portosystemic shunt in the management of portal vein thrombosis: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2018; 30 (10) 1187-1193
    CrossrefPubMedGoogle Scholar
  • 131 Fanelli F, Angeloni S, Salvatori FM. et al. Transjugular intrahepatic portosystemic shunt with expanded-polytetrafuoroethylene-covered stents in non-cirrhotic patients with portal cavernoma. Dig Liver Dis 2011; 43 (01) 78-84
    CrossrefPubMedGoogle Scholar
  • 132 Kochar N, Tripathi D, Arestis NJ, Ireland H, Redhead DN, Hayes PC. Tipsitis: incidence and outcome-a single centre experience. Eur J Gastroenterol Hepatol 2010; 22 (06) 729-735
    CrossrefPubMedGoogle Scholar
  • 133 Sterling KM, Darcy MD. Stenosis of transjugular intrahepatic portosystemic shunts: presentation and management. AJR Am J Roentgenol 1997; 168 (01) 239-244
    CrossrefPubMedGoogle Scholar
  • 134 Wolf DC, Siddiqui S, Rayyan Y, Rozenblit G. Emergent stent occlusion for TIPS-induced liver failure. Dig Dis Sci 2005; 50 (12) 2356-2358
    CrossrefPubMedGoogle Scholar
  • 135 Saad WE. Balloon-occluded retrograde transvenous obliteration of gastric varices: concept, basic techniques, and outcomes. Semin Intervent Radiol 2012; 29 (02) 118-128
    Article in Thieme ConnectPubMedGoogle Scholar
  • 136 Saad WE, Kitanosono T, Koizumi J, Hirota S. The conventional balloon-occluded retrograde transvenous obliteration procedure: indications, contraindications, and technical applications. Tech Vasc Interv Radiol 2013; 16 (02) 101-151
    CrossrefPubMedGoogle Scholar
  • 137 Chu HH, Kim M, Kim HC, Lee JH, Jae HJ, Chung JW. Long-term outcomes of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices: a comparison of ethanolamine oleate and sodium tetradecyl sulfate. Cardiovasc Intervent Radiol 2018; 41 (04) 578-586
    CrossrefPubMedGoogle Scholar
  • 138 Kim DJ, Darcy MD, Mani NB. et al. Modified Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Techniques for the Treatment of Gastric Varices: Vascular Plug-Assisted Retrograde Transvenous Obliteration (PARTO)/Coil-Assisted Retrograde Transvenous Obliteration (CARTO)/Balloon-Occluded Antegrade Transvenous Obliteration (BATO). Cardiovasc Intervent Radiol 2018; 41 (06) 835-847
    CrossrefPubMedGoogle Scholar
  • 139 Cho SK, Shin SW, Do YS. et al. Development of thrombus in the major systemic and portal veins after balloon-occluded retrograde transvenous obliteration for treating gastric variceal bleeding: its frequency and outcome evaluation with CT. J Vasc Interv Radiol 2008; 19 (04) 529-538
    CrossrefPubMedGoogle Scholar