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Portal Hypertension

Portal Hypertension

Portal hypertension is an increase in blood pressure within the portal venous system. Normally, this pressure is less than 5 mmHg. It is considered clinically significant when it rises above 10 mmHg. At this threshold, complications from altered blood flow and venous congestion emerge.EtiologyPortal hypertension arises from conditions that impede blood flow through the liver. The most common cause is cirrhosis, in which chronic liver injury leads to fibrotic scarring. This fibrosis narrows or...

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Related Experiment Video

Updated: Apr 30, 2026

Invasive Hemodynamic Characterization of the Portal-hypertensive Syndrome in Cirrhotic Rats

Invasive Hemodynamic Characterization of the Portal-hypertensive Syndrome in Cirrhotic Rats

Published on: August 1, 2018

Early Dynamics of Portal Pressure Gradient After TIPS Insertion Predict Mortality.

P A Reuken¹, A Franz¹, T H Wirtz²

¹Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.

Alimentary Pharmacology & Therapeutics

|January 16, 2025

Summary

Early hemodynamic changes after transjugular intrahepatic portosystemic shunt (TIPS) placement significantly impact patient survival. A lack of increased portal pressure gradient (ΔPPG) 24 hours post-TIPS indicates higher mortality risk.

Keywords:

TIPS ascites cirrhosis portal pressure gradient

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Last Updated: Apr 30, 2026

Invasive Hemodynamic Characterization of the Portal-hypertensive Syndrome in Cirrhotic Rats

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Published on: August 1, 2018

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Area of Science:

Hepatology
Interventional Radiology
Cardiovascular Physiology

Background:

Transjugular intrahepatic portosystemic shunt (TIPS) placement improves outcomes for patients with refractory ascites and variceal hemorrhage.
Current survival prediction relies on pre-TIPS factors, with limited data on early post-procedure hemodynamic changes.
Refining post-TIPS management requires understanding the impact of early hemodynamic shifts on survival.

Purpose of the Study:

To evaluate the influence of early hemodynamic changes after TIPS placement on patient survival.
To identify early indicators for refining post-TIPS patient management.
To assess the predictive value of the change in portal pressure gradient (ΔPPG) on survival.

Main Methods:

A prospective, bicentric study included 105 patients undergoing TIPS placement.
Portal pressure gradient (PPG) was measured at TIPS insertion (PPG0) and 24 hours later (PPG24h).
The change in portal pressure gradient (ΔPPG = PPG24h - PPG0) was calculated, and survival analyses were performed.

Main Results:

Patients with a lack of increased ΔPPG demonstrated significantly poorer 90-day and 1-year survival rates compared to those with increased ΔPPG.
This finding remained independent of established prognostic scores like MELD, Child-Pugh, and the Freiburg index of post-TIPS survival (FIPS).
Within the high-risk group (lack of ΔPPG increase), elevated bilirubin levels (>25 μmol/L) further stratified survival outcomes.

Conclusions:

A lack of increased ΔPPG 24 hours post-TIPS insertion identifies a high-risk patient cohort with diminished survival.
Incorporating early post-TIPS PPG measurements (ΔPPG) into clinical practice can facilitate early identification of at-risk patients.
This approach allows for tailored post-TIPS management strategies to improve patient outcomes.