Management of portal hypertension severe complications
Alberto Zanetto1, Giulio Barbiero2, Michele Battistel2
1Unit of Gastroenterology and Multivisceral Transplant, Department of Surgery, Oncology, and Gastroenterology, University Hospital of Padua, Padua, Italy.
Insights
Portal hypertension, often caused by cirrhosis, leads to serious complications. This review covers interventional treatments for conditions like ascites and variceal hemorrhage, aiding clinical practice.
Area of Science:
- Hepatology
- Interventional Radiology
- Gastroenterology
Background:
- Portal hypertension is a clinical syndrome marked by increased portal pressure, frequently stemming from cirrhosis.
- In cirrhotic patients, portal hypertension drives disease progression and hepatic decompensation (ascites, variceal hemorrhage, hepatic encephalopathy).
- Treatment for decompensated patients focuses on reducing mortality by preventing further decompensation and acute-on-chronic liver failure.
Purpose of the Study:
- To review current knowledge on interventional treatments for portal hypertension complications.
- To provide practical information for hepatologists managing patients with portal hypertension.
- To discuss indications, contraindications, and applications of specific interventional procedures.
Main Methods:
- Review of interventional treatments for portal hypertension complications.
- Discussion of transjugular intra-hepatic portosystemic shunt (TIPS) for gastro-esophageal variceal hemorrhage.
- Review of interventional treatments for Budd-Chiari Syndrome and portal vein thrombosis.
- Commentary on selective splenic embolization applications.
Main Results:
- Detailed discussion on transjugular intra-hepatic portosystemic shunt (TIPS) for managing gastro-esophageal variceal hemorrhage in decompensated cirrhosis.
- Comprehensive review of interventional strategies for hepatic vein obstruction (Budd-Chiari Syndrome) and portal vein thrombosis.
- Overview of selective splenic embolization for patients with and without cirrhosis.
Conclusions:
- Interventional treatments play a crucial role in managing complications of portal hypertension.
- A multidisciplinary approach is essential for complex decompensated cirrhotic patients.
- This review offers valuable insights into the application of interventional radiology in hepatology.
Abstract:
Portal hypertension is a clinical syndrome characterized by an increase in the portal pressure gradient, defined as the gradient between the portal vein at the site downstream of the site of obstruction and the inferior vena cava. The most frequent cause of portal hypertension is cirrhosis. In patients with cirrhosis, portal hypertension is the main driver of cirrhosis progression and development of hepatic decompensation (ascites, variceal hemorrhage and hepatic encephalopathy), which defines the transition from compensated to decompensated stage. In decompensated patients, treatments aim at lowering the risk of death by preventing further decompensation and/or development of acute-on-chronic liver failure. Decompensated patients often pose a complex challenge which typically requires a multidisciplinary approach. The aims of the present review were to discuss the current knowledge regarding interventional treatments for patients with portal hypertension complications as well as to highlight useful information to aid hepatologists in their clinical practice. Specifically, we discussed the indications and contraindications of transjugular intra-hepatic portosystemic shunt and for the treatment of gastro-esophageal variceal hemorrhage in patients with decompensated cirrhosis (first section); we reviewed the use of interventional treatments in patients with hepatic vein obstruction (Budd-Chiari Syndrome) and in those with portal vein thrombosis (second section); and we briefly comment on the most frequent applications of selective splenic embolization in patients with and without underlying cirrhosis (third section).
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