Endovascular surgery in the treatment of portal hypertension complications
https://doi.org/10.16931/1995-5464.2024-4-16-24
Abstract
Aim. To describe the main endovascular interventions used in portal hypertension. The paper presents modern endovascular procedures for treating patients with portal hypertension and varicose transformation of the esophageal and gastric veins: transjugular intrahepatic portosystemic shunt, balloon-occluded retrograde transvenous obliteration, balloon-occluded antegrade transvenous obliteration, partial embolization of the splenic arteries and gastric veins. The study extensively discusses the radical shunting surgery related to portal hypertension – transjugular intrahepatic portosystemic shunt. The paper involves historical aspects of the development of this treatment procedure, indications, techniques, variations depending on the nature of the disease and clinical situation, along with an analysis of the surgical approach in the event of endovascular intervention complications.
About the Authors
I. I. Zatevakhin
Pirogov Russian National Research Medical University of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Igor I. Zatevakhin – Doct. of Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Head of the Department of Faculty Surgery, Pirogov Russian National Research Medical University.
1, Ostrivityanova str., Moscow 117997
V. N. Shipovskiy
Pirogov Russian National Research Medical University of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Vladimir N. Shipovskiy – Doct. of Sci. (Med.), Professor, Department of Faculty Surgery, Pirogov Russian National Research Medical University.
1, Ostrivityanova str., Moscow 117997
M. Sh. Tsitsiashvili
Pirogov Russian National Research Medical University of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Mihail Sh. Tsitsiashvili – Doct. of Sci. (Med.), Professor, Department of Faculty Surgery, Pirogov Russian National Research Medical University.
1, Ostrivityanova str., Moscow 117997
D. V. Monakhov
Pirogov Russian National Research Medical University of the Ministry of Healthcare of the Russian Federation; V.V. Pletnev City Clinical Hospital of Moscow Healthcare Department
Russian Federation
Russian Federation
Dmitry V. Monakhov – Cand. of Sci. (Med.), Associate Professor, Department of Faculty Surgery, Pirogov Russian National Research Medical University; Surgeon, Pletnev City Clinical Hospital.
1, Ostrivityanova str., Moscow 117997; 32, 11th Parkovaya str., Moscow 105077
References
1. Rösch J., Hanafee W.N., Snow H. Transjugular portal venography and radiologic portocaval shunt: an experimental study. Radiology. 1969; 92 (5): 1112–1114. https://doi.org/10.1148/92.5.1112.
2. Prokubovsky V.I., Cherkasov V.A., Zubarev A.R. Transhepatic Endovascular Portacaval Shunt. Grekov's Bulletin of Surgery. 1990; 144 (6): 48–50. PMID: 2175499 (In Russian)
3. Palmaz J.C., Sibbitt R.R., Reuter S.R., Garcia F., Tio F.O. Expandable intrahepatic portosystemic shunt: early experience in the dog. AJR Am. J. Roentgenol. 1985; 145 (4): 821–825. https://doi.org/10.2214/ajr.145.4.821
4. Richter G.M., Palmaz J.C., Nöldge G., Rössle M., Siegerstetter V., Franke M., Wenz W. Der transjuguläre intrahepatische portosystemische Stent-Shunt (TIPSS). Eine neue nichtoperative, perkutane Methode [The transjugular intrahepatic portosystemic stent-shunt. A new nonsurgical percutaneous method]. Radiologe. 1989; 29 (8): 406–411. PMID: 2798853 (In German)
5. Zatevakhin I.I., Shipovsky V.N., Tsitsishvili M.S., Monakhov D.V. Portal'naya gipertenziya. Diagnostika i lechenie [Portal Hypertension. Diagnosis and Treatment]. Moscow: Buki-Vedi, 2015. 328 p. (In Russian)
6. Saad W.E., Darwish W.M., Davies M.G., Waldman F.L. Stents-grafts for TIPS creation: specialized TIPS stent-graft versus generic stent-graft/bare stent combination. J. Vasc. Radiol. 2010; 21 (10): 1512–1520. https://doi.org/10.1016/j.jvir.2010.06.009
7. Zatevakhin I.I., Shipovskiy V.N., Tsitsiashvili M.Sh, Monakhov D.V., Zabadaeva O.B. First use of “Sandwich”-technique for the transjugular intrahepatic portosystemic shunt procedure. Endovascular Surgery. 2022; 9 (4): 389–395. https://doi.org/10.24183/2409-4080-2022-9-4-389-395 (In Russian)
8. Durleshter V.M., Bukhtoyarov A.Yu., Chukhoev S.V., Lyaskovskiy K.O., Nikitin S.P. Coronary technique using in transugular intra-hepatic portosystem shunting operations. Nauchnyj byulleten' zdravoohraneniya Kubani = Scientific Bulletin of Kuban Healthcare. 2016; 48 (6): 36–43. (In Russian)
9. Hascal Z.L., Martin S., Cardella J.F. Quality improvement guidelines for TIPS. J. Vasc. Interv. Radiol. 2003; 14: 265.
10. Petersen B., Uchida B.T., Timmermans H., Keller F.S., Rosch J. Intravascular US-guided direct intrahepatic portacaval shunt with a PTFE-covered stent-graft: feasibility study in swine and initial clinical results. J. Vasc. Interv. Radiol. 2001; 12 (4): 475–486. https://doi.org/10.1016/s1051-0443(07)61887-9
11. Quinn S.F., Sheley R.C., Semonsen K.G. Creation of a portal vein to inferior vena cava shunt using CT guidance and a covered endovascular stent. AJR Am. J. Roentgenol. 1997; 169 (4): 1159–1160. https://doi.org/10.2214/ajr.169.4.9308482
12. Pieper C.C., Sprinkart A.M., Nadal J., Hippe V., Meyer C., Schild H.H., Thomas D. Postinterventional passive expansion of partially dilated transjugular intrahepatic portosystemic shunt stents. J. Vasc. Interv. Radiol. 2015; 26 (3): 388–394. https://doi.org/10.1016/j.jvir.2014.10.021
13. Kanagawa H., Mima S., Kouyama H., Gotoh K., Uchida T., Okuda K. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J. Gastroenterol. Hepatol. 1996; 11 (1): 51–58. https://doi.org/10.1111/j.1440-1746.1996.tb00010.x
14. Chikamori F., Kuniyyoshi N., Shibuya S., Takase Y. Eight years of experience with transjugular obliteration balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal shunt. Surgery. 2001; 129 (4): 414–420. https://doi.org/10.1067/msy.2001.112000
15. Maddison F.E. Embolic therapy of hypersplenism. Invest. Rаdiol. 1973; 8: 280–281.
16. Shabunin A.V., Bedin V.V., Drozdov P.A., Levina O.N., Tsurkan V.A., Zhuravel O.S., Astapovich S.A. The first experience of partial spleen embolization for the correction of thrombocytopenia in patients with liver cirrhosis. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2021; 26 (3): 97–103. https://doi.org/10.16931/1995-5464.2021-3-97-103 (In Russian)
17. Prokubovsky V.I., Cherkasov V.A. Vozmozhnosti endovaskulyarnyh vmeshatelstv pri lechenii oslozhneniy portalnoy gipertenzii. Spornye voprosy hirurgicheskogo lecheniya portalnoy gipertenzii u bolnyh cirrozom pecheni [Potential of Endovascular Interventions in Treating Complications of Portal Hypertension. Controversial Issues in Surgical Treatment of Portal Hypertension in Patients with Liver Cirrhosis]. Tashkent, 1988. P. 114–115. (In Russian)
Review
For citations:
Zatevakhin I.I., Shipovskiy V.N., Tsitsiashvili M.Sh., Monakhov D.V. Endovascular surgery in the treatment of portal hypertension complications. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2024;29(4):16-24. (In Russ.) https://doi.org/10.16931/1995-5464.2024-4-16-24
Views:
280
Email this article 