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Updated: Sep 20, 2025
09:37
Invasive Hemodynamic Characterization of the Portal-hypertensive Syndrome in Cirrhotic Rats
Published on: August 1, 2018
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Imaging-guided interventions modulating portal venous flow: Evidence and controversies
Roberto Cannella1,2,3, Lambros Tselikas4,5,6, Fréderic Douane7
1Université Paris Cité; AP-HP, Hôpital Beaujon, Service de Radiologie, Clichy; Centre de Recherche sur l'inflammation Inserm, UMR 1149, Paris, France.
JHEP Reports : Innovation in Hepatology
|June 9, 2022
Summary
Portal hypertension, often caused by liver disease, increases pressure in the portal vein. Imaging-guided interventions like shunts and recanalisation offer effective treatments by managing portal blood flow.
Area of Science:
- Interventional Radiology
- Hepatology
- Vascular Surgery
Background:
- Portal hypertension is characterized by elevated portosystemic venous gradient, primarily due to increased portal blood flow resistance.
- Advanced chronic liver disease and cirrhosis account for over 90% of portal hypertension cases.
- Extrahepatic portal vein thrombosis or compression can also cause portal hypertension.
Purpose of the Study:
- To provide a comprehensive evidence-based review of imaging-guided interventions for portal vein management.
- To discuss the rationale, outcomes, and controversies surrounding these interventional approaches.
Main Methods:
- Review of transjugular intrahepatic portosystemic shunts (TIPS) for bypassing hepatic resistance.
- Analysis of percutaneous portal vein recanalisation for restoring portal trunk patency.
- Examination of portal vein embolisation for modulating hepatic volume before resection.
Main Results:
- TIPS effectively bypass hepatic resistance in portal hypertension.
- Percutaneous recanalisation restores portal vein patency, preventing complications.
- Portal vein embolisation aids in liver regeneration for extended resections.
Conclusions:
- Imaging-guided portal vein interventions are crucial for managing portal hypertension and its complications.
- These techniques offer distinct benefits in diverse clinical scenarios, from treating established hypertension to preparing for surgery.
- Further discussion on controversies surrounding these approaches is warranted for optimized patient care.
Keywords:
ALPPS, associating liver partition and portal vein ligation for staged hepatectomyBSG, British Society of GastroenterologyEASL, European Association for the Study of the LiverFLR, future liver remnantHE, hepatic encephalopathyNCBA, N-butyl cyanoacrylatePH, portal hypertensionPVE, portal vein embolisationPVR, portal vein recanalisationPortal vein interventionsRCT, randomised controlled trialTACE, trans-arterial chemoembolizationTIPS, transjugular intrahepatic portosystemic shuntimage guidedportal hypertensionportal vein embolizationportal vein recanalizationtransjugular intrahepatic portosystemic shunt
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