Transjugular Intrahepatic Portosystemic Shunting (TIPS Procedure) and its Influence on Portosystemic Hemodynamics in Patients with Portal Hypertension

Abstract

Aim. To study the peculiarities of portosystemic hemodynamics in patients with cirrhotic portal hypertension before and after TIPS procedure and to identify its influence on the development of typical complications of portal hypertension including bleeding from gastric and esophageal varices, ascites and hepatorenal syndrome.
Material and Methods. The TIPS procedure was performed in 136 patients with complicated cirrhotic portal hypertension. Surgical anatomy of liver vascular system and porto-hepatic hemodynamics have been studied using CT-splenoportography, Doppler ultrasonography of portal vein system and CT- angiography portal and hepatic veins. The surgical results were evaluated on various dates postoperatively with the period rate of 3–6 months. Results. Portal vein’s and hepatic veins’ angioarchitecture in a context of TIPS procedure was studied. Algorithm of intrahepatic portosystemic canal creation with the direction determined by surgeon is developed. It gives the opportunity to reach the optimal parameters of shunt’s hemodynamics. It is established decrease of portal pressure and portosystemic venous pressure gradient after surgical intervention. Consideration of anatomic features while forming the intrahepatic
portosystemic shunt makes it possible to achieve stable portal decompression even in the environment of significant cirrhotic process. Conclusion. TIPS procedure enables to effectively decrease portal vein system pressure, normalize portosystemic hemodynamics indicators and significantly promote prevention of complications induced by portal hypertension.