Direct intrahepatic portocaval shunt (DIPS) or transjugular transcaval intrahepatic portosystemic shunt (TTIPS) to treat complications of portal hypertension: Indications, technique, and outcomes beyond Budd-Chiari syndrome - 28/05/22
Highlights |
• | Due to unfavourable anatomy for TIPS, 5–10% of patients could be eligible patients to the DIPS or TTIPS techniques as an alternative procedure. |
• | At the end of these procedures (DIPS or TTIPS), a stent linking the portal circulation to the vena cava is in place. |
• | A highly successful procedure rate was reported (81% to 100%) with a significant drop in the portosystemic gradient of 13 mmHg (62%) and primary and secondary patency rates at one year ranging between 66% and 100%. |
• | These procedures appear to be safe and potential lifesaving alternatives to TIPS. |
• | In an era marked by the broadening indication of conventional TIPS, it is worthwhile ensuring hepatologists and interventional radiologists are aware of these techniques to propose them in selected patients when conventional TIPS appears not feasible. |
Abstract |
Transjugular intrahepatic portosystemic shunt (TIPS) is nowadays the benchmark treatment of severe portal hypertension complications. However, besides usual contraindication to the procedure (namely recurrent hepatic encephalopathy, severe liver dysfunction, right heart failure and/or pulmonary hypertension), TIPS appears regularly unfeasible due to abnormal and/or distorted anatomy. In this situation, the only non-surgical approaches to treat severe portal hypertension consist in the creation of an intrahepatic portocaval shunt from percutaneous (direct intrahepatic portocaval shunt - DIPS) or transjugular route (transjugular transcaval intrahepatic portosystemic shunt – TTIPS). These procedures have been rapidly adopted in patients with Budd-Chiari syndrome but are only poorly reported in patients with cirrhosis and without BCS. Considering the broadening landscape of TIPS indication in patients with cirrhosis within the last ten years, we aimed to describe the techniques, safety and efficacy of DIPS and TTIPS procedures as an alternative to TIPS in case of unfavourable anatomy.
Le texte complet de cet article est disponible en PDF.Keywords : Direct intrahepatic portocaval shunt (DIPS), Transjugular transcaval intrahepatic portosystemic shunt (TTIPS), Transjugular intrahepatic portosystemic shunt (TIPS), Cirrhosis, Portal hypertension (PH)
Plan
Vol 46 - N° 4
Article 101858- avril 2022 Retour au numéro
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