Techniques in Vascular and Interventional Radiology最新文献

The purpose of this manuscript is to review the indications, technical details, limitations, and complications of nonconventional techniques for transjugular intrahepatic portosystemic shunt creation. We describe alternative nonconventional techniques for TIPS creation when the conventional technique is unsuccessful.

Changes in body composition, including the reversal of sarcopenia, after transjugular intrahepatic portosystemic shunt (TIPS) creation have been reported to impact morbidity and mortality. This systematic review aims to identify changes in body composition that could serve as markers for post-TIPS outcomes in patients with cirrhosis. Electronic databases including Ovid Medline, Embase, and Central Register of Controlled Trials were searched from inception to February 5, 2025 to analyze the impact of changes in body composition on post-TIPS outcomes in patients with cirrhosis. A total of 16 studies were included in the review. Most studies reported that post-TIPS skeletal muscle gain often caused a reversal of sarcopenia (18%-66%) and contributed to improvements in morbidity and mortality. In particular, patients with pre-TIPS sarcopenia received the greatest benefit. Skeletal muscle index showed the most substantial increase within 6 months after TIPS creation, while the psoas muscle index or the transverse psoas muscle thickness/ height increased as early as 1-3 months after TIPS creation. Reversal of sarcopenia after TIPS creation may contribute to improvements in morbidity and mortality in cirrhosis. Skeletal muscle tends to show the most substantial increase within 6 months after TIPS creation, with the psoas muscle index observed as an early imaging biomarker. Further research is needed to identify the underlying physiologic mechanisms responsible for these observed body composition changes and to prospectively assess the impact on clinical outcomes.

Portal vein embolization (PVE) is a minimally invasive intervention that has become the standard of care in preoperative liver augmentation for patients undergoing extended hepatic resections for primary and secondary liver cancers. PVE provides permanent and complete occlusion of the portal venous inflow to diseased hepatic segments, re-directing portal flow to the future liver remnant and inducing hypertrophy sufficient to proceed to major hepatectomy. The aim of this review is to discuss the methods of identifying an insufficient future liver remnant, technical considerations for performing effective PVE, and the alternative/adjunctive measures for PVE.

Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure used to manage complications of portal hypertension, including most frequently refractory ascites and variceal bleeding. While TIPS has established indications, contraindications, and procedural guidelines, its scope is expanding with advancements in technology and improved evidence-based patient selection criteria. This article reviews the current indications and contraindications for TIPS, examines potential expanding applications, and discusses consensus guidelines from organizations such as the Society of Interventional Radiology (SIR), Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and American Association for the Study of Liver Diseases (AASLD).

Portal hypertension is a complex and multifaceted condition that arises from increased resistance to portal blood flow, often secondary to prehepatic, intrahepatic, or post hepatic etiologies. The most common cause of portal hypertension in the United States is cirrhosis, which leads to structural and dynamic changes in the liver, exacerbating portal resistance and triggering a cascade of complications. Accurate diagnosis and management are critical to mitigating these risks and improving patient outcomes. Noninvasive imaging techniques, including ultrasound, CT, MRI, and elastography, have revolutionized the diagnosis and monitoring of portal hypertension. These modalities provide qualitative and quantitative measures of liver and spleen stiffness, portal vein flow, and morphological changes, enabling early risk stratification and intervention. Invasive techniques, such as hepatic venography with pressure measurement, remain the gold standard for diagnosing portal hypertension, particularly in for cases where in which noninvasive methods are inconclusive. Direct portal pressure measurement, although more invasive than these other techniques, is occasionally necessary in specific clinical scenarios. Liver biopsy, whether percutaneous, transjugular, or transfemoral, remains a crucial tool for histopathological diagnosis and guiding treatment strategy guidance, particularly in cases of chronic liver disease. Diagnosis of portal hypertension, which involves accurate measurement of portal pressure, is essential for early risk stratification and effective management. The available noninvasive and invasive techniques for the diagnosis of portal hypertension are reviewed here.

Portal hypertension is a hemodynamic consequence of altered mesenteric circulation. The chief drivers of portal hypertension are rising hepatic resistance and venous remodeling. A major challenge in treating patients with portal hypertension is early diagnosis because most patients progress through disease asymptomatically. Noninvasive tests such as serologic markers and elastography are the basis of determining if patients have clinically significant portal hypertension. If identified early, patients placed on carvedilol and who undergo etiologic cure may be able to delay or avert decompensation altogether. This paper reviews the pathophysiology, diagnosis, and medical management of portal hypertension.

Management of portal hypertension commonly involves the creation of a transjugular intrahepatic portosystemic shunt (TIPS). Despite significant advancement in procedural techniques, hepatic encephalopathy (HE) continues to be one of the most consequential complications following TIPS creation. In this manuscript, we describe in detail several factors associated with the clinical condition of patients and TIPS creation that increase the likelihood of post TIPS development of hepatic encephalopathy. We also discuss the management of the post-TIPS encephalopathic patient.