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Spondylodiscitis associated with recurrent Serratia bacteremia due to a transjugular intrahepatic portosystemic shunt (TIPS): a case report

Marques, Nuno; Sá, Rosa; Coelho, Filomena; Cunha, Saraiva da; Meliço-Silvestre, A.
Fonte: SciELO Publicador: SciELO
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
46.79%
We report a case of spondylodiscitis caused by multiresistant Serratia marcescens in a cirrhotic patient who had several Serratia bacteremias after the placement of a transjugular intrahepatic portosystemic shunt (TIPS) device. We concluded that an endovascular stent that can not be removed makes management of recurrent bacteremia difficult. Furthermore, back pain due to bacteremia is indicative of spondylodiscitis. Serratia marcescens can be an aggressive pathogen, causing spinal infection

Long-Term Follow-Up After Successful Transjugular Intrahepatic Portosystemic Shunt Placement in a Pediatric Patient with Budd-Chiari Syndrome

CARNEVALE, Francisco Cesar; SZEJNFELD, Denis; MOREIRA, Airton Mota; GIBELLI, Nelson; GREGORIO, Miguel Angel De; TANNURI, Uenis; CERRI, Giovanni Guido
Fonte: SPRINGER Publicador: SPRINGER
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
67.05%
Orthotopic liver transplantation is the standard of care in patients with Budd-Chiari syndrome (BCS), and transjugular intrahepatic portosystemic shunt (TIPS) has become an important adjunct procedure while the patient is waiting for a liver. No long-term follow up of TIPS in BCS patients has been published in children. We report successful 10-year follow-up of a child with BCS and iatrogenic TIPS dysfunction caused by oral contraceptive use.

Hepatic Veins and Inferior Vena Cava Thrombosis in a Child Treated by Transjugular Intrahepatic Portosystemic Shunt

CARNEVALE, Francisco Cesar; SANTOS, Aline Cristine Barbosa; TANNURI, Uenis; CERRI, Giovanni Guido
Fonte: SPRINGER Publicador: SPRINGER
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
67.05%
We report the case of a 9-year-old boy with portal hypertension, due to Budd-Chiari syndrome, and retrohepatic inferior vena cava thrombosis, submitted to a transjugular intrahepatic portosystemic shunt (TIPS) by connecting the suprahepatic segment of the inferior vena cava directly to the portal vein. After 3 months, the withdrawal of anticoagulants promoted the thrombosis of the TIPS. At TIPS revision, thrombosis of the TIPS and the main portal vein and clots at the splenic and the superior mesenteric veins were found. Successful angiography treatment was performed by thrombolysis and balloon angioplasty of a severe stenosis at the distal edge of the stent.

Spondylodiscitis associated with recurrent Serratia bacteremia due to a transjugular intrahepatic portosystemic shunt (TIPS): a case report

Marques, N; Sá, R; Coelho, F; Saraiva da Cunha, JG; Meliço-Silvestre, A
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Artigo de Revista Científica
Publicado em //2009 ENG
Relevância na Pesquisa
56.94%
We report a case of spondylodiscitis caused by multiresistant Serratia marcescens in a cirrhotic patient who had several Serratia bacteremias after the placement of a transjugular intrahepatic portosystemic shunt (TIPS) device. We concluded that an endovascular stent that can not be removed makes management of recurrent bacteremia difficult. Furthermore, back pain due to bacteremia is indicative of spondylodiscitis. Serratia marcescens can be an aggressive pathogen, causing spinal infection.

Spondylodiscitis associated with recurrent Serratia bacteremia due to a transjugular intrahepatic portosystemic shunt (TIPS): a case report

Marques,Nuno; Sá,Rosa; Coelho,Filomena; Cunha,Saraiva da; Meliço-Silvestre,A.
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2007 EN
Relevância na Pesquisa
46.79%
We report a case of spondylodiscitis caused by multiresistant Serratia marcescens in a cirrhotic patient who had several Serratia bacteremias after the placement of a transjugular intrahepatic portosystemic shunt (TIPS) device. We concluded that an endovascular stent that can not be removed makes management of recurrent bacteremia difficult. Furthermore, back pain due to bacteremia is indicative of spondylodiscitis. Serratia marcescens can be an aggressive pathogen, causing spinal infection.

Conversion of failed transjugular intrahepatic portosystemic shunt to distal splenorenal shunt in patients with Child A or B cirrhosis.

Selim, N; Fendley, M J; Boyer, T D; Galloway, J R; Branum, G D
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1998 EN
Relevância na Pesquisa
46.79%
OBJECTIVE: The authors demonstrate the feasibility of converting failed transjugular intrahepatic portosystemic shunt (TIPS) to distal splenorenal shunt (DSRS) in patients with good hepatic reserve for long-term control of variceal bleeding. SUMMARY BACKGROUND DATA: TIPS is an effective method for decompressing the portal venous system and controlling bleeding from esophageal and gastric varices. TIPS insufficiency is, however, a common problem, and treatment alternatives in patients with an occluded TIPS are limited because most have already failed endoscopic therapy. METHODS: The records of five patients who underwent conversion from TIPS to DSRS because of TIPS failure or complication in the past 36 months were reviewed. RESULTS: Four patients had ethanol-induced cirrhosis and one patient had hepatitis C virus cirrhosis. Three patients were Child-Pugh class A and two were class B. All patients had excellent liver function, with galactose elimination capacities ranging from 388 to 540 mg/min (normal 500 +/- 100 mg/min). The patients had TIPS placed for acute (2) or sclerotherapy-resistant (3) variceal hemorrhage. All five TIPS stenosed 3 to 23 months after placement, with recurrent variceal hemorrhage and failed TIPS revision. One patient had stent migration to the superior mesenteric vein that was removed at the time of DSRS. All five patients underwent successful DSRS...

Transjugular intrahepatic portasystemic stent shunting for control of acute and recurrent upper gastrointestinal haemorrhage related to portal hypertension.

Simpson, K J; Chalmers, N; Redhead, D N; Finlayson, N D; Bouchier, I A; Hayes, P C
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /07/1993 EN
Relevância na Pesquisa
46.79%
The insertion of a transjugular intrahepatic portasystemic stent shunt (TIPSS) was evaluated in 22 patients with recurrent upper gastrointestinal haemorrhage related to portal hypertension (bleeding from oesophageal varices 10, gastric varices six, portal hypertensive gastropathy six). TIPSS was successfully performed electively in 15 patients and as an emergency in three patients. Twelve patients have had no further admissions with bleeding after TIPSS. Single episodes of bleeding were noted in six patients after TIPSS associated with shunt thrombosis (two), intimal hyperplasia within the shunt (two), and shunt migration (one). Another patient presented with reaccumulated ascites suggesting poor shunt function but died from massive variceal haemorrhage before further assessment could be performed. There was one death related to the procedure. Two patients developed encephalopathy after TIPSS, in one patient this was controlled by the insertion of a smaller diameter stent within the existing TIPSS. Several complications arose in earlier patients that have not recurred after modification of the initial technique. TIPSS can be life saving and is effective in controlling variceal haemorrhage and rebleeding from oesophageal or gastric varices and portal hypertensive gastropathy. Larger and longer term studies are required...

Bleeding anorectal varices: successful treatment with transjugular intrahepatic portosystemic shunting (TIPS).

Fantin, A C; Zala, G; Risti, B; Debatin, J F; Schöpke, W; Meyenberger, C
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/1996 EN
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A patient with severe recurrent rectal bleeding from anorectal varices due to portal hypertension because of hepatitis C virus related liver cirrhosis is presented. As illustrated by the report, it is essential to differentiate bleeding anorectal varices from bleeding haemorrhoids because treatment is different. In our patient, implantation of a transjugular intrahepatic portosystemic shunt (TIPS) led to an impressive regression of the anorectal varices, which could be demonstrated by sigmoidoscopy, endosonography, and magnetic resonance imaging. Recurrent rectal bleeding in a patient with portal hypertension should alert the physician to consider anorectal varices. Endoscopic ultra-sound and magnetic resonance imaging are new and non-invasive modalities for diagnosis and post-treatment control.

Haemodynamic adaptation two months after transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients.

Colombato, L A; Spahr, L; Martinet, J P; Dufresne, M P; Lafortune, M; Fenyves, D; Pomier-Layrargues, G
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /10/1996 EN
Relevância na Pesquisa
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BACKGROUND AND AIMS: In portal hypertensive patients, transjugular intrahepatic portosystemic shunt (TIPS) acutely increases cardiac output and exaggerates peripheral vasodilatation. It has been suggested that the worsened hyperdynamic state may progress to high output heart failure. The aim was to evaluate the acute and short-term haemodynamic adaptation to this procedure. METHODS: Systemic, splanchnic, and pulmonary haemodynamics were studied in 15 cirrhotic patients under stable haemodynamic conditions before placement of TIPS, then 15-30 minutes after and two months later. For inclusion in the final analysis, an uneventful post-TIPS at two months follow up and a stable portacaval gradient were required. The following variables were measured or calculated: portacaval gradient; cardiac index (thermodilution); systolic and diastolic mean arterial, atrial, pulmonary arterial, and wedged pulmonary capillary pressures; heart rate; and total peripheral and pulmonary vascular resistances. Blood flow in the shunt was measured using duplex Doppler ultrasound. RESULTS: The portacaval gradient decreased by 56% and remained stable thereafter. Shunt blood flow was unchanged when measured immediately after TIPS and two months later. Immediately after TIPS there was a pronounced increase in cardiac index (+32%; p < 0.05) in association with a decrease in peripheral and pulmonary vascular resistance (-21%; p < 0.05 and -14%; NS). Two months later...

Longterm follow up of transjugular intrahepatic portosystemic stent shunt (TIPSS) for the treatment of portal hypertension: results in 130 patients.

Stanley, A J; Jalan, R; Forrest, E H; Redhead, D N; Hayes, P C
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /09/1996 EN
Relevância na Pesquisa
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BACKGROUND: Transjugular intrahepatic portosystemic stent shunts (TIPSS) are increasingly being used to manage the complications of portal hypertension. This study reports on the follow up on 130 patients who have undergone TIPSS. PATIENTS AND METHODS: One hundred and thirty patients (81 male), mean (SD) age 54.7 (12.5) years underwent TIPSS. The majority (64.6%) had alcoholic cirrhosis and 53.2% had Childs C disease. Indications were: variceal haemorrhage (76.2%), refractory ascites (13.1%), portal hypertensive gastropathy (4.6%), others (6.1%). Shunt function was assessed by Doppler ultrasonography and two then six monthly portography and mean follow up for survivors was 18.0 months (range 2-43.5). RESULTS: The procedure was successful in 119 (91.5%). Sixty three episodes of shunt dysfunction were observed in 45 (37.8%) patients. Variceal rebleeding occurred in 16 (13.4%) patients and was always associated with shunt dysfunction. Twenty (16.8%) patients had new or worse spontaneous encephalopathy after TIPSS and 11 (64.7%) patients had an improvement in resistant ascites. Thirty day mortality was 21.8% and one year survival 62.5%. CONCLUSION: TIPSS is an effective treatment for variceal bleeding, resistant ascites, and portal hypertensive gastropathy. Rebleeding is invariably associated with shunt dysfunction...

Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study

Brensing, K; Textor, J; Perz, J; Schiedermaier, P; Raab, P; Strunk, H; Klehr, H; Kramer, H; Spengler, U; Schild, H; Sauerbruch, T
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /08/2000 EN
Relevância na Pesquisa
47.05%
BACKGROUND—Recent small studies on hepatorenal syndrome (HRS) indicate some clinical benefit after transjugular intrahepatic portosystemic stent-shunt (TIPS) but sufficient long term data are lacking.
AIM—We studied prospectively feasibility, safety, and long term survival after TIPS in 41 non-transplantable cirrhotics with HRS (phase II study).
PATIENTS AND METHODS—HRS was diagnosed using current criteria (severe (type I) HRS, n=21; moderate (type II) HRS, n=20). Thirty one patients (14 type I, 17 type II) received TIPS (8-10 mm) while advanced liver failure excluded shunting in 10. During follow up (median 24 months) we analysed renal function and survival (Kaplan-Meier).
RESULTS—TIPS markedly reduced the portal pressure gradient (21 (5) to 13 (4) mm Hg (mean (SD)); p<0.001) with one procedure related death (3.2%). Renal function deteriorated without TIPS but improved (p<0.001) within two weeks after TIPS (creatinine clearance 18 (15) to 48 (42) ml/min; sodium excretion 9 (16) to 77 (78) mmol/24 hours) and stabilised thereafter. Following TIPS, three, six, 12, and 18 month survival rates were 81%, 71%, 48%, and 35%, respectively. As only 10% of non-shunted patients survived three months, total survival rates were 63%...

Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial

Pomier-Layrargues, G; Villeneuve, J; Deschenes, M; Bui, B; Perreault, P; Fenyves, D; Willems, B; Marleau, D; Bilodeau, M; Lafortune, M; Dufresne, M
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /03/2001 EN
Relevância na Pesquisa
47.05%
BACKGROUND AND AIMS—The transjugular intrahepatic portosystemic shunt (TIPS) is a new therapeutic modality for variceal bleeding. In this study we compared the two year survival and rebleeding rates in cirrhotic patients treated by either variceal band ligation or TIPS for variceal bleeding.
METHODS—Eighty cirrhotic patients (Pugh score 7-12) with variceal bleeding were randomly allocated to TIPS (n=41) or ligation (n=39), 24 hours after control of bleeding.
RESULTS—Mean follow up was 581 days in the ligation group and 678 days in the TIPS group. The two year survival rate was 57% in the TIPS group and 56% in the ligation group (NS); the incidence of variceal rebleeding after two years was 18% in the TIPS group and 66% in the ligation group (p<0.001). Uncontrolled rebleeding occurred in 11 patients in the ligation group (eight were rescued by emergency TIPS) but in none of the TIPS group. The incidence of encephalopathy at two years was 47% in the TIPS group and 44% in the ligation group (NS).
CONCLUSIONS—TIPS did not increase the two year survival rate compared with variceal band ligation after variceal bleeding in cirrhotic patients with moderate or severe liver failure. It significantly reduced the incidence of variceal rebleeding without increasing the rate of encephalopathy.


Keywords: portal hypertension; cirrhosis; variceal bleeding; transjugular intrahepatic portosystemic shunt; variceal band ligation

Hepatic Perfusion and Hemodynamic Effects of Transjugular Intrahepatic Portosystemic Shunts

Walser, Eric M.; Nguyen, Michael
Fonte: Thieme Medical Publishers Publicador: Thieme Medical Publishers
Tipo: Artigo de Revista Científica
Publicado em /12/2005 EN
Relevância na Pesquisa
46.91%
The liver depends on a dual blood supply from the hepatic artery and the portal vein. The normal liver receives 70% portal flow and 30% hepatic arterial flow, with most arterial blood feeding the biliary tree. As cirrhosis robs the liver of its regenerative capacity, the portal flow decreases and intrahepatic portosystemic shunting increases with a variable increase in arterial flow across arterioportal shunts. This compensation mechanism attempts to reperfuse remaining sinusoids. Transjugular intrahepatic portosystemic shunts (TIPS) or surgical portosystemic shunts may acutely diminish portal perfusion further, leading to hepatic failure. Small-diameter TIPS or surgical shunts reduce the incidence of complications by preserving nutritive portal flow. Although the inverse relationship of arterial and portal flow is physiologically valid, there is individual variation in the ability to substitute one blood supply for another. This variability may result from anatomic or functional factors influencing the flow across arterioportal shunts. Hepatic perfusion curves derived from enhanced imaging studies can subtype cirrhotic patients into favorable versus unfavorable perfusion patterns. Patients with high arterial flow to the liver or patients with retained portal-type flow curves have better survival and morbidity compared with those patients with unfavorable flow manifest by diminished arterial-type curves on hepatic perfusion analysis.

Acute symptomatic mesenteric venous thrombosis: treatment by catheter-directed thrombolysis with transjugular intrahepatic route

Wang, Mao Qiang; Liu, Feng Yong; Duan, Feng; Wang, Zhi Jun; Song, Peng; Fan, Qing Sheng
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
47.27%
Objective: To assess the feasibility and effectiveness of transjugular intrahepatic route aspiration thrombectomy and catheter-directed thrombolytic therapy in patients with acute superior mesenteric venous thrombosis. Materials and methods: During a period of 8 years, 12 patients with acute thrombosis of the superior mesenteric vein (SMV) were treated by transjugular intrahepatic approach. The mean age was 41.2 years. After access to the portal system via the transjugular approach, the pigtail catheter fragmentation of the thrombus, local urokinase injection, and manual aspiration thrombectomy were used for treatment of the SMV thrombosis initially, followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV, which was performed for 2 to 6 days (4.2 ± 1.8 days). The adequacy of anticoagulation was performed during treatment, throughout hospitalization, and after discharge. Results: Technical success was achieved in all 12 patients. Substantial clinical improvement was seen in these patients after the procedure. Minor complications at the jugular puncture site were observed in 4 patients, but the thrombolytic therapy was not interrupted. Contrast-enhanced computed tomography (CT) scan before discharge demonstrated nearly complete disappearance of SMV thrombosis in all patients. The 12 patients were discharged 5–10 days (7.6 ± 2.0) after admission. Mean duration of follow-up after hospital discharge was 37.7 months...

Transjugular intrahepatic portosystemic shunt using the FLUENCY expanded polytetrafluoroethylene-covered stent

WU, QINGHUA; JIANG, JIANWEI; HE, YUJIE; JIANG, TIANPENG; ZHOU, SHI
Fonte: D.A. Spandidos Publicador: D.A. Spandidos
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
47.05%
The aim of this study was to evaluate the feasibility of transjugular intrahepatic portosystemic shunts using FLUENCY expanded polytetraf luoroethylene (PTFE)-covered stents and the effect on the patency rate. A total of 114 cirrhotic patients who were treated by transjugular intrahepatic portosystemic stent shunt (TIPS) placement using a FLUENCY expanded, PTFE-covered stent were enrolled in the present study. Of the patients, 15 underwent an additional bare metal stent implantation on the portal side of the covered stent, simultaneously. Patients underwent Doppler sonography during the follow-up. Mean portal venous pressure dropped from 2.499±0.588 cmHg to 1.764±0.294 cmHg. The cumulative patency rates for one and two years were 86.7% and 75.2%, respectively. The results demonstrate the feasibility of TIPS placement with the FLUENCY expanded PTFE-covered stent. TIPS placement with the FLUENCY expanded PTFE-covered stent was able to improve patency when compared with the use of conventional bare-metal stents.

Intravascular ultrasound guidance for transjugular intrahepatic portosystemic shunt procedure in a swine model

Kew, Jacqueline; Davies, Roger Phillip
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Publicado em //2004 EN
Relevância na Pesquisa
67.05%
A new method is described for guiding hepato-portal venous puncture using a longitudinal side-view intravascular ultrasound (L-IVUS) transducer to assist in the performance of transjugular intrahepatic portosystemic shunt (TIPS) in three Australian swine. Simultaneous L-IVUS with an AcuNav® 5–10 MHz 10 Fr transducer (Acuson Corporation, Mountain View, CA, USA) and fluoroscopy guidance was used to image and monitor the hepatic to portal venous puncture, dilatation of the tract, and deployment of the TIPS stent. Flow through the shunt could be demonstrated with both L-IVUS and angiography. TIPS was successful in all swine. The time for portal vein puncture once the target portal vein was identified was reduced at each attempt. The number of portal vein puncture attempts was 2, 1, and 1. No post-procedural complication was evident. L-IVUS-guided TIPS is practical and has the potential to improve safety by permitting simultaneous ultrasound and fluoroscopic imaging of the needle and target vascular structures. This technique allows for a more streamlined approach to TIPS, decreasing the fluoroscopic time (hence, decreasing the radiation exposure to the staff and patient) and anesthetic time. In addition, there are improved safety benefits obviating the need for wedged portography...

Vergleich schnittbildmorphologischer und klinischer Stigmata portaler Hypertension und Leberzirrhose bei Patienten mit Anlage eines Transjugulären Intrahepatischen Portosystemischen Shunts (TIPSS); Comparison of signs of portal hypertension in imaging data (CT-scans and MRI) and clinical manifestations of portal hypertension in patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement

Batsching, Katharina Frederike
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
DE_DE
Relevância na Pesquisa
67.05%
Portale Hypertension ist eine häufige Folge zahlreicher Lebererkrankungen und kann mit schwerwiegenden Komplikationen einhergehen. Die Standardmethode zur Evaluation des portosystemischen Druckgradienten ist die invasive, blutige Druckmessung. Zusätzlich gibt es Ansätze, den portosystemischen Druckgradienten noninvasiv abzuschätzen, da die invasive Messung nicht überall verfügbar ist und Riskiken birgt. Zur Zeit sind die Methoden zur noninvasiven Druckgradientenabschätzung der invasiven Messung unterlegen. Diese Arbeit beschäftigt sich mit Zusammenhängen zwischen bildmorphologischen, klinischen und laborchemischen Stigmata portaler Hypertension und dem portosystemischen Druckgradienten vor und nach einer Anlage eines Transjugulären Intrahepatischen Portosystemischen Shunts (TIPSS). Ziel war, Erkenntnisse herauszuarbeiten, die weiteren Ansätzen der noninvasiven Abschätzung des portosystemischen Druckgradienten zugute kommen können. In diese Studie wurden die Daten von Patienten in die Studie eingeschlossen, welche zwischen Januar 2002 und August 2008 eine Anlage eines TIPSS erhielten, der portosystemische Druckgradient prä- und postinterventionell dokumentiert wurde und bei welchen eine präinterventionelle Computertomographie oder Magnetresonanztomographie des Abdomens vorlag. Insgesamt 70 Patienten erfüllten die Einschlusskriterien. Zusätzlich zu den erhobenen bildmorphologischen Charakteristika wurden retrospektiv klinische und laborchemische Daten...

The transjugular intrahepatic portosystemic shunt.; Shunt porto-sistémico intra-hepático transjugular.

Pisco, J M; Serviço de Radiologia, Hospital de Santa Marta, Lisboa.; Martins, J M; Garcia, V; Correia, M G; Figueiredo, M L; Jalles, N; Freitas, J M; Leal, F C
Fonte: Ordem dos Médicos Publicador: Ordem dos Médicos
Tipo: info:eu-repo/semantics/article; article; article; info:eu-repo/semantics/publishedVersion Formato: application/pdf
Publicado em 30/03/1994 POR
Relevância na Pesquisa
47.14%
The case of a 66-year-old woman with several episodes of hemorrhage by esophageal varices and ascites due to portal hypertension is presented. Despite 4 sessions of endoscopic sclerotherapy bleeding recurred. A transjugular intrahepatic portosystemic shunt was performed. In the 10 months following the intervention, there was no further hemorrhage, the ascites disappeared and the shunt is open.; The case of a 66-year-old woman with several episodes of hemorrhage by esophageal varices and ascites due to portal hypertension is presented. Despite 4 sessions of endoscopic sclerotherapy bleeding recurred. A transjugular intrahepatic portosystemic shunt was performed. In the 10 months following the intervention, there was no further hemorrhage, the ascites disappeared and the shunt is open.

Mortality and complications in patients with portal hypertension who underwent transjugular intrahepatic portosystemic shunt (TIPS) - 12 years experience

Funes,Fernanda Ribeiro; Silva,Rita de C. M. A. da; Arroyo Jr.,Paulo César; Duca,William José; Silva,Adinaldo Adhemar Menezes da; Silva,Renato Ferreira da
Fonte: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE ; Colégio Brasileiro de Cirurgia Digestiva - CBCD ; Sociedade Brasileira de Motilidade Digestiva - SBMD ; Federação Brasileira de Gastroenterologia - FBG; Sociedade Brasileira de Hepatologia - SBH; Sociedade Brasileira de Endoscopia Digestiva - SOBED Publicador: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE ; Colégio Brasileiro de Cirurgia Digestiva - CBCD ; Sociedade Brasileira de Motilidade Digestiva - SBMD ; Federação Brasileira de Gastroenterologia - FBG; Sociedade Brasileira de Hepatologia - SBH; Sociedade Brasileira de Endoscopia Digestiva - SOBED
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2012 EN
Relevância na Pesquisa
67.05%
CONTEXT: Transjugular intrahepatic portosystemic shunt (TIPS) is the non-surgical treatment option with low level of morbi-mortality and possibility of accomplishment in patients with severe hepatic dysfunction which aims at decompressing the portal system treating or reducing the portal hypertension complications. OBJECTIVE: Outline the profile analyze global and early mortality, and the complications presented by cirrhotic patients who underwent TIPS for treatment of digestive hemorrhage by portal hypertension. METHOD: Retrospective study based on the data bank of cirrhotic patients' medical reports, who underwent TIPS for digestive hemorrhage by portal hypertension treatment who did not respond to clinical endoscopic treatment, and were assisted from 1998 to 2010 in the Liver Transplant Service at a university hospital. The study was approved by the Committee of Ethics and Research. RESULTS: The sample was comprised of 72 (84.7%) patients, being 57 (79.2%) males, average age 47.7 years (age range from 16 to 85 years and SD = 13), 21 (29.2%) patients presented liver disease as cause excessive intake of alcoholic drinks; 21 (29.2%) contamination by hepatitis virus, 16 (22.2%) excessive alcohol intake associated with virus and 14 (19.4%) patients presented other causes. As for initial classification...

A prospective trial of transjugular intrahepatic portasystemic stent shunts versus small-diameter prosthetic H-graft portacaval shunts in the treatment of bleeding varices.

Rosemurgy, A S; Goode, S E; Zwiebel, B R; Black, T J; Brady, P G
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /09/1996 EN
Relevância na Pesquisa
47.21%
OBJECTIVE: The authors compare transjugular intrahepatic portasystemic stent shunts (TIPS) to small-diameter prosthetic H-graft portacaval shunts (HGPCS). SUMMARY BACKGROUND DATA: Transjugular intrahepatic portasystemic stent shunts have been embraced as a first-line therapy in the treatment of bleeding varices due to portal hypertension, although they have not been compared to operatively placed shunts in a prospective trial. METHODS: In 1993, the authors began a prospective, randomized trial to compare TIPS with HGPCSs. All patients had bleeding varices and had failed nonoperative management. Shunting was undertaken as definitive therapy in all. Failure of shunting was defined as an inability to accomplish shunting despite repeated attempts, unexpected liver failure leading to transplantation, irreversible shunt occlusion, major variceal rehemorrhage, or death. Mortality and failure rates were analyzed at 30 days (early) and after 30 days (late) using Fischer's exact test. RESULTS: There were 35 patients in each group, with no difference in age, gender, Child's class, etiology of cirrhosis, urgency of shunting, or incidence of ascites or encephalopathy between groups. In two patients, TIPS could not be placed despite repeated attempts. Transjugular intrahepatic portasystemic stent shunts reduced portal pressures from 32 +/- 7.5 mmHg (standard deviation) to 25 +/- 7.5 mmHg (p < 0.01)...