Background: Lumboperitoneal (LP) shunts have been used to manage benign intracranial hypertension (BIH) for an extended period. While they may swiftly and effectively alleviate symptoms, their application is accompani...Background: Lumboperitoneal (LP) shunts have been used to manage benign intracranial hypertension (BIH) for an extended period. While they may swiftly and effectively alleviate symptoms, their application is accompanied by potential complications. Objectives: This research aimed to retrospectively analyze the difficulties and complications related to LP shunt implantation. Methods: We conducted a retrospective analysis of the records of 47 patients who had LP shunt placement for the treatment of BIH at our hospital throughout the research period. A thorough history and physical examination were conducted in every case. All patients were asked about age, gender, body mass index, neurological history, and oral contraceptive usage. Post-operative complications, clinical and ophthalmological follow-up occurred at 1, 3, and 6 months post-op. Results: Patients were mostly women (93.6%). The mean age of the patients was 35, and 80.9 percent had BMIs exceeding 25. Many female patients (40.9%) used oral contraceptives. Nearly all patients (93.6%) reported decreased vision, and 87.2% suffered headaches. The most common issue was shunt obstruction (51%), followed by low tension headaches (63.8%). The peritoneal side (10.6%) had higher shunt slippage than the thecal (2.1%). Superficial infections and radiculopathy affected 10.6% of patients, whereas CNS infections, arachnoiditis, and shunt failure affected just 2.1%. Five patients (10.6%) had Chiari malformation, and 60% had syringomyelia. Conclusion: Using LP shunts to treat BIH seems to be a method devoid of major risks despite the high revision rates. At the same time, more severe complications such as CNS infections, arachnoiditis, and shunt failure were less common.展开更多
BACKGROUND The use of intravascular ultrasound(iUS)has been shown in multiple singlecenter retrospective studies to decrease procedure time,radiation exposure,and needle passes compared to conventional fluoroscopic gu...BACKGROUND The use of intravascular ultrasound(iUS)has been shown in multiple singlecenter retrospective studies to decrease procedure time,radiation exposure,and needle passes compared to conventional fluoroscopic guidance in the creation of a transjugular intrahepatic portosystemic shunt(TIPS).However,there are few data regarding the impact of imaging guidance modality choice on clinical outcomes.AIM To determine the impact of iUS vs fluoroscopic guidance during creation of a TIPS on procedural metrics,liver injury,shunt patency and mortality.METHODS The retrospective study cohort consisted of 66 patients who underwent TIPS creation using iUS[“iUS-guided TIPS(iTIPS)group”]and 135 patients who underwent TIPS creation using fluoroscopic guidance[“conventional fluoroscopic-guided TIPS(cTIPS)group”]at 2 tertiary academic medical centers from 2015-2019.TIPS that required variceal embolization or portal vein recanalization were excluded.RESULTS The technical success rate was 100%in the iTIPS group and 96%in the cTIPS group(P=0.17).The iTIPS group had an air kerma(266±254 mGy vs 1235±1049 mGy,P<0.00001),dose area product(5728±6518 uGy×m^(2) vs 28969±19067 uGy×m^(2),P<0.00001),fluoroscopy time(18.7±9.6 minutes vs 32.3±19.0 minutes,P<0.00001),and total procedure time(93±40 minutes vs 110±51 minutes,P=0.01)which were significantly lower than the cTIPS group.There was no significant difference in liver function test adverse event grade at 1 month.With a median follow-up of 26 months(inter quartile range:6-61 months),there was no difference between the two groups in terms of thrombosis-free survival(P=0.23),intervention-free survival(P=0.29),or patient mortality(P=0.61).CONCLUSION The use of iUS in the creation of TIPS reduces radiation exposure and procedure time compared with fluoroscopic guidance.At midterm follow-up,the imaging guidance modality did not affect shunt patency or mortality.展开更多
BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an est...BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an established treatment for PH-related complications,including refractory ascites,variceal bleeding,hepatic hydrothorax and Budd-Chiari syndrome.However,post-TIPS cardiac decompensation has been reported in up to 25%of patients,often due to haemodynamic shifts revealing occult cardiac dysfunction.Current approaches to pre-procedural cardiac assessment and risk stratification remain inconsistent.This systematic review examines current recommendations and emerging strategies for cardiovascular evaluation in patients with cirrhosis prior to a TIPS.AIM To identify the key predictive factors for cardiac decompensation following a TIPS in patients with cirrhosis.METHODS A systematic review of available literature,using PubMed(including MEDLINE),Embase and Cochrane databases.Results were searched comprehensively,without exclusion criteria,from inception to May 2025.Given the predominance of retrospective cohort studies,risk of bias assessment was primarily performed using the ROBINS-E tool.RESULTS Thirteen studies were included(n=1674 patients),with a pulled mean decompensation rate of 8.8%.Due to the variability in TIPS timing,study quality and heterogeneity,a meta-analysis was not feasible,therefore results were synthesised narratively.Multiple diastolic dysfunction parameters independently and integrated through the American Society of Echocardiography guidelines demonstrated predictive value.Newly validated risk score,heart failure with preserved ejection fraction,and biomarkers such as N-terminal pro-B-type natriuretic peptide≥125 pg/mL consistently highlight cardiac dysfunction amongst the literature.Our review also explored left-atrial strain imaging as well as recent advances in cardiac magnetic resonance imaging and potential genetic contributors.CONCLUSION Multiple predictors of cardiac decompensation following TIPS exist,however studies are of limited quality.Implementing reliable markers may enable early risk stratification,candidate selection and guide pre-procedural optimisation.展开更多
In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following tran...In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and treatment.By comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy group.The gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome therapies.Furthermore,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated PH.Despite these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal models.In conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.展开更多
Objective:To investigate the usefulness of the descending aortic retrograde flow area to forward flow area(dAO RF)ratio using echocardiography in managing pulmonary blood flow during the perioperative period following...Objective:To investigate the usefulness of the descending aortic retrograde flow area to forward flow area(dAO RF)ratio using echocardiography in managing pulmonary blood flow during the perioperative period following Blalock-Thomas-Taussig shunt(BTTS)surgery.Methods:This retrospective study analyzed patient characteristics,surgical procedures,and perioperative courses.The dAO RF ratio was measured upon admission to the pediatric intensive care unit(PICU)and 12,24,48,and 72 h post-surgery.Blood pressure,percutaneous oxygen saturation,arterial blood gas values,and lactate levels were measured at the same time as the dAO RF ratio.Results:Seventy-one cases were analyzed.Excessive and low pulmonary blood flow occurred in 17 and two patients,respectively.Four patients required resuscitation within 72 h post-surgery,due to excessive pulmonary blood flow.No deaths occurred within 72 h.The dAO RF ratio was significantly higher in patients with excessive pulmonary blood flow at PICU admission and at its maximum(p=0.049 and p<0.01,respectively).The maximum dAO RF ratio was significantly correlated with lactate levels when measured concurrently;however,there was clinical variability in the resuscitation cases.The dAO RF ratio cutoff of 0.61 was highly accurate(area under the receiver operating characteristic curve:0.91[95%confidence interval:0.82-1.00]),sensitive(82.4%),and specific(94.4%)for detecting excessive pulmonary blood flow.Conclusions:Measuring the dAO RF ratio postoperatively can prevent deterioration in patients with BTTS by accurately detecting excessive pulmonary blood flow,offering a minimally invasive and accurate assessment of perioperative pathophysiology.展开更多
Background Pulmonary arterial hypertension (PAH) is a progressive condition with a poorprognosis in children. Lung transplantation (Ltx) remains the ultimate option when patients are refractory toPAH-speciffc therapy....Background Pulmonary arterial hypertension (PAH) is a progressive condition with a poorprognosis in children. Lung transplantation (Ltx) remains the ultimate option when patients are refractory toPAH-speciffc therapy. Reverse Potts shunt (RPS) has been introduced to treat suprasystemic PAH. This studyaims to investigate the clinical outcomes of suprasystemic PAH in children. Methods Embase, Pubmed,and the Cochrane Library databases were searched for related studies that reported the clinical outcomes ofsuprasystemic PAH following RPS in children. To investigate the clinical outcomes of RPS, meta-analyses ofthe early and overall mortalities were performed. Results Nine studies were included in this study. Theestimated early mortality was 14.4% (95% CI, 7.1% to 23.1%), and the overall mortality/Ltx was 23.2% (95%CI, 14.4% to 32.9%). The estimated 1-year survival was 86.3% (95% CI, 75.9% to 88.7%). A qualitative reviewshowed that the median value of 5-year survival free from Ltx of patients undergoing RPS was 68.6% (range:65% to 92.3%). Compared to Ltx, RPS did not signiffcantly increase the early mortality (OR, 2.48, 95% CI0.75 to 8.24, p = 0.14). RPS also signiffcantly improved the New York Heart Association/World HealthOrganization functional class, reduced the BNP/NT-pro BNP levels, decreased the PAH-speciffc therapy,and increased the six-minute-walking distance. Conclusions RPS may serve as an alternative treatmentfor suprasystemic drug-refractory PAH. Further large-scale and prospective cohort studies are needed tovalidate these ffndings.展开更多
BACKGROUND Hepatic encephalopathy(HE)affects more than 30%of patients with cirrhosis.Extrahepatic portosystemic shunt(EHPSS)has been suggested to be a contributing factor to HE recurrence and mortality.Therefore,early...BACKGROUND Hepatic encephalopathy(HE)affects more than 30%of patients with cirrhosis.Extrahepatic portosystemic shunt(EHPSS)has been suggested to be a contributing factor to HE recurrence and mortality.Therefore,early detection and intervention in EHPSS may improve patient outcomes.AIM To evaluate the effects of shunt embolization on mortality and HE recurrence.METHODS In this retrospective case-control study,16 cirrhotic patients with HE treated at a tertiary care center from January 2012 to August 2022 were included.Outcomes in eight patients who underwent embolization of EHPSS were compared with those in eight patients receiving standard care without embolization.Data on baseline characteristics,HE recurrence,and overall survival were collected and analyzed using Kaplan-Meier and log-rank tests.RESULTS Baseline characteristics were comparable between the groups.The 1-year overall survival rate was significantly higher in the treatment group(0.50)than in the control group(0.33).The HE recurrence-free rate was also higher in the treatment group(1.00)than in the control group(0.17).The median survival duration was longer in the treatment group{not reached[95%confidence interval(CI):23.84 to not available(NA)]}than in the control group[15.02 months(95%CI:9.86 to NA)](P=0.006).Similarly,the recurrence-free duration was longer in the treatment group[63.09 months(95%CI:63.09 to NA)]than in the control group[9.21 months(95%CI:4.47 to NA)](P=0.006).EHPSS embolization significantly reduced 1-year HE recurrence(hazard ratio=0.09;95%CI:0.01-0.75;P=0.026).CONCLUSION EHPSS embolization significantly improves 1-year survival and prevents recurrence of HE in cirrhotic patients.Routine computed tomography and early embolization are clinically beneficial.展开更多
BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incide...BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incidence post-TIPS across various groups and the prophylactic efficacies of various medications.METHODS A thorough literature search was performed in PubMed,Web of Science,EMBASE,and the Cochrane Library databases from their inception to November 24,2024,to collect data regarding HE incidence.The main outcome was HE incidence post-TIPS.A meta-analysis using a random effects model was performed to obtain odds ratios(ORs)and 95%confidence intervals.Statistical analyses were conducted using Stata and RevMan software.RESULTS This meta-analysis included nine studies with 1140 patients;647 received pharmacological agents including lactulose,rifaximin,albumin,and l-ornithin-l-aspartate,and 493 did not(controls).(1)In the single-group meta-analysis,the control group had higher short-and long-term HE rates than the drug intervention group.Among patients with and without prior HE,the non-intervention group's HE rates were also higher;(2)Pharmacological prevention post-TIPS significantly reduced HE incidence[OR=0.59(0.45,0.77),P=0.0001].Compared with the no prophylaxis,rifaximin reduced the risk of HE after TIPS[OR=0.52(0.29,0.95),P=0.03],but lactulose did not;(3)In patients without prior HE,pharmacological prevention significantly reduced post-TIPS HE incidence[OR=0.62(0.41,0.95),P=0.03];and(4)Network meta-analysis showed no significant differences among five prevention strategies.CONCLUSION The HE incidence after TIPS was relatively high,and the use of drugs after TIPS may reduce the HE incidence.However,research,especially large-scale randomized controlled trials,is still lacking.展开更多
BACKGROUND Heart failure(HF),especially in patients with preserved ejection fraction and midrange ejection fraction,remains a significant global health burden.Interatrial shunt devices(IASDs),which allow blood flow fr...BACKGROUND Heart failure(HF),especially in patients with preserved ejection fraction and midrange ejection fraction,remains a significant global health burden.Interatrial shunt devices(IASDs),which allow blood flow from the left to the right atrium,offer a novel treatment approach by reducing left atrial pressure and alleviating symptoms.AIM To evaluate the efficacy and safety of IASDs in patients with HF through a systematic review and meta-analysis.METHODS We performed a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines,analyzing studies up to April 2025.Randomized controlled trials and observational studies comparing interatrial shunt therapy with control groups were included.Data on clinical outcomes were analyzed using Review Manager software.RESULTS Nine studies involving 1689 patients were included.IASDs significantly improved cardiac output[mean difference(MD):0.72,95%CI:0.13-1.32,P=0.02],right atrial pressure(RAP)(MD:0.70,95%CI:0.14-1.26,P=0.01),and 6-minute walk distance(MD:71.63,95%CI:24.13-119.13,P=0.003).There were no significant differences in major adverse cardiac events,myocardial infarction,ischemic stroke,or new-onset atrial fibrillation.However,all-cause mortality[risk ratio(RR):1.49,95%CI:1.02-2.18,P=0.04]and cardiovascular death(RR:1.66,95%CI:1.01-2.74,P=0.05)were significantly higher in the shunt group.CONCLUSION IASDs offer significant short-term improvements in cardiac output,RAP,and exercise capacity in HF patients.However,long-term safety concerns,particularly regarding mortality,necessitate further research and careful patient selection.展开更多
Since the beginning of the 20th century,alkaline electrolysis has been used as a proven method for producing hydrogen on a megawatt scale.The existence of parasitic shunt currents in alkaline water electrolysis,which ...Since the beginning of the 20th century,alkaline electrolysis has been used as a proven method for producing hydrogen on a megawatt scale.The existence of parasitic shunt currents in alkaline water electrolysis,which is utilized to produce clean hydrogen,is investigated in this work.Analysis has been done on a 20-cell stack.Steel end plates,bipolar plates,and an electrolyte concentration of 6 M potassium hydroxide are all included in the model.The Butler-Volmer kinetics equations are used to simulate the electrode surfaces.Ohmic losses are taken into consideration in both the electrode and electrolyte phases,although mass transport constraints in the gas phase are not.Using an auxiliary sweep to solve equations,the model maintains an isothermal condition at 85℃ while adjusting the average cell voltage between 1.3 and 1.8 V.The results show that lower shunt currents in the outlet channels as opposed to the intake channels are the result of the electrolyte’s lower effective conductivity in the upper channels,which is brought on by a lower volume fraction of the electrolyte.Additionally,it has been seen that the shunt currents intensify as the stack gets closer to the conclusion.Efficiency is calculated by dividing the maximum energy output(per unit of time)that a fuel cell operating under comparable conditions might produce by the electrical energy needed to generate that output inside the stack.At first,energy efficiency increases due to the rise in coulombic efficiency,peaking around 1400 mA.The subsequent decline after reaching 1400 mA is linked to an increase in stack voltage at elevated current levels.展开更多
The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic ...The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic shunt(TIPS).Both treatment modalities have demonstrated efficacy;however,each presents distinct challenges and benefits.NSBBs,including propranolol,nadolol,and carvedilol,effectively reduce portal pressure,but are associated with side effects such as bradycardia,hypotension,fatigue,and respiratory issues.Additionally,NSBBs can exacerbate conditions such as refractory ascites,hepatorenal syndrome,and hepatic encephalopathy.In contrast,TIPS effectively reduces the incidence of variceal rebleeding,controlling refractory ascites.However,it is associated with a significant risk of hepatic encephalopathy,shunt dysfunction,and procedurerelated complications including bleeding and infection.The high cost of TIPS,along with the need for regular follow-up and potential re-intervention,poses additional challenges.Furthermore,patient selection for TIPS is critical,as inappropriate candidates may experience suboptimal outcomes.Future studies comparing NSBBs and TIPS should focus on refining the patient selection criteria,enhancing procedural techniques,optimising combination therapies,and conducting long-term outcome studies.Personalised treatment approaches,costeffectiveness analyses,and improved patient education and support are essential for maximising the use of these therapies.展开更多
Transjugular intrahepatic portosystemic shunt(TIPS)is widely used to treat portal hypertension and its complications patients with cirrhosis.However,managing post-TIPS hepatic encephalopathy(HE)remains a major clinica...Transjugular intrahepatic portosystemic shunt(TIPS)is widely used to treat portal hypertension and its complications patients with cirrhosis.However,managing post-TIPS hepatic encephalopathy(HE)remains a major clinical challenge.HE is characterized by a high incidence and a complex pathogenesis,influenced by various factors.Therefore,careful patient assessment and selection for TIPS is essential.While previous studies have identified several factors contributing to the occurrence of post-TIPS HE,there is a gap in the comprehen-sive integration of surgical procedural parameters and metabolic mechanisms within a multidimensional analysis.This minireview aims to optimize treatment protocols and refine management strategies by conducting a comprehensive analysis of risk factors,ultimately aiming to reduce the incidence of post-TIPS HE.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentia...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentially serious complication following TIPS creation.Timely identification and management are crucial for preventing further adverse events.CASE SUMMARY We report a 56-year-old male patient who underwent a TIPS procedure for re-current melena caused by portal hypertension secondary to hepatitis B and experienced a stent fracture 15 months post-procedure.He was readmitted 30 months after the initial TIPS due to recurrent esophagogastric variceal bleeding and ascites.An attempt to revise the dysfunctional shunt via a stent-in-stent approach was unsuccessful.Consequently,a parallel TIPS procedure was success-fully performed via the proximal end of the fractured stent to decompress the portal venous system.At the 1-month follow-up,the patient exhibited no recur-rent variceal bleeding,and his ascites had significantly decreased.Twelve-month postoperative monitoring revealed no hepatic encephalopathy and no recurrence of bleeding or ascites.Additionally,we review the existing literature on post-TIPS stent fractures to explore the underlying mechanisms contributing to this com-plication.CONCLUSION Early recognition and prompt intervention are essential in managing stent fractures after TIPS creation to mitigate potential risks and ensure optimal patient outcomes.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)has an important role in the therapy of complications of portal-hypertension-related ascites.Various guidelines now indicate that TIPS is indicated for ref...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)has an important role in the therapy of complications of portal-hypertension-related ascites.Various guidelines now indicate that TIPS is indicated for refractory ascites(RA),but TIPS for recurrent nonrefractory ascites(RNRA)achieved better clinical results.AIM To compare the clinical outcomes of TIPS for RA and RNRA in patients with complications related to portal hypertension.METHODS There were 863 patients divided into two main categories who underwent TIPS between September 2016 and September 2021.In category 1,patients had ascites without cirrhotic gastrointestinal bleeding.The patients were divided into group A(RNRA,n=183)and group B(RA,n=217).In category 2,patients had ascites and cirrhotic gastrointestinal bleeding.The patients were divided into group C(RNRA,n=328)and group D(RA,n=135).The clinical outcomes were probability of total hepatic impairment,incidence of hepatic encephalopathy(HE)and mortality.RESULTS The symptoms of ascites disappeared or were relieved within 1 week in group A compared with group B(P=0.032),and in group C compared with group D(P=0.027).By the end of follow-up,there were significant differences in the rate of RA in group A compared with group B(P=0.016),and in group C compared with group D(P=0.012).The probability of total hepatic impairment was significantly different in group A compared with group B(P=0.024),and in group C compared with group D(P=0.019).The total incidence of HE was significantly different in group A compared with group B(P=0.008),and in group C compared with group D(P=0.004).The 6-month,and 1-,2-and 3-year survival rates were significantly different between groups A and B(all P<0.05),and between groups C and D(all P<0.05).CONCLUSION TIPS has a good therapeutic effect on ascites related to cirrhotic portal hypertension,and early TIPS for RNRA can prolong survival,and prevent progression to RA.展开更多
BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively ...BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively reduces portal pressure,predicting long-term survival remains challenging due to the multifactorial nature of patient outcomes.Accurate survival prediction tools are lacking,and existing models often omit critical factors such as portal vein diameter.This study aimed to develop and validate a nomogram incorporating key clinical and biochemical variables to predict 1-year and 2-year survival following TIPS in PHT patients.We hypothesized that this model would provide improved risk stratification and guide clinical decisions.AIM To develop and validate a nomogram for predicting 1-year and 2-year survival in PHT patients post-TIPS.METHODS This retrospective cohort study included 848 TIPS-treated PHT patients with gastrointestinal bleeding from two tertiary hospitals(2013-2021).Mortality was the primary endpoint.Predictive variables were selected using least absolute shrinkage and selection operator regression,and a nomogram was developed with Cox regression to predict 1-year and 2-year survival.Model performance was evaluated through receiver operating characteristic curves,calibration plots,and decision curve analysis.RESULTS The mean age of the included(848)patients was 53.00 years±12.51,where 69.58%were men.Results showed that portal vein diameter,serum creatinine,potassium,and alpha-fetoprotein were the independent predictors of post-TIPS survival.Besides,the model showed strong discriminatory ability(C-index,0.816 in the training set;0.827 in the validation set)and good calibration.The area under the curve for 1-year and 2-year survival in the training set were 0.890[95%confidence interval(CI):0.802-0.948]and 0.838(95%CI:0.803-0.869),respectively.The area under the curve for 1-year and 2-year survival in the validation set were 0.934(95%CI:0.815-0.987)and 0.864(95%CI:0.811-0.907),respectively.CONCLUSION The developed nomogram could reliably predict 1-year and 2-year survival in patients undergoing TIPS for PHTinduced gastrointestinal bleeding.展开更多
BACKGROUND Portal hypertension(PHT),a complication of liver cirrhosis,is sometimes managed with transjugular intrahepatic portosystemic shunt(TIPS)to reduce portal pressure.Although effective,TIPS poses risks,includin...BACKGROUND Portal hypertension(PHT),a complication of liver cirrhosis,is sometimes managed with transjugular intrahepatic portosystemic shunt(TIPS)to reduce portal pressure.Although effective,TIPS poses risks,including hepatic enceph-alopathy(HE).This study investigates whether a significant reduction in the portal pressure gradient(PPG)after TIPS improves outcomes in PHT patients.AIM To evaluate the impact of post-TIPS PPG reduction on clinical outcomes and explore the relationship between PPG reduction and portal vein diameter.METHODS This retrospective cohort study included 815 patients with PHT who underwent TIPS at two tertiary hospitals between 2014 and 2022.Patients were categorized based on whether they achieved a 50%reduction in PPG.Propensity score matching was applied to balance baseline characteristics.Kaplan-Meier analysis assessed clinical outcomes,including rebleeding,HE,liver failure,and hepato-cellular carcinoma.Cox regression identified risk factors,and Spearman correlation analyzed the relationship between PPG reduction and portal vein diameter.RESULTS Patients with a PPG reduction>50%had significantly lower risks of rebleeding(P=0.004),shunt dysfunction(P=0.002),and mortality(P=0.024)compared to those with a PPG reduction≤50%.However,these patients faced higher risks of HE(P<0.001)and liver failure(P=0.003).A significant negative correlation was observed between the percentage of PPG reduction and portal vein diameter(ρ=-0.632,P<0.001),suggesting that patients with smaller portal vein diameters may achieve greater PPG reductions.CONCLUSION A significant PPG reduction following TIPS is associated with improved clinical outcomes,including reduced risks of rebleeding,shunt dysfunction,hepatocellular carcinoma,and mortality,though it increases HE and liver failure risks.The observed correlation between portal vein diameter and PPG reduction highlights the potential role of portal vein anatomy in predicting TIPS efficacy,warranting further investigation.展开更多
This is a narrative review in which the advances in technical aspects,the main indications,limitations and clinical results of the transjugular intrahepatic portosystemic shunt(TIPS)in portal hypertension(PH)are addre...This is a narrative review in which the advances in technical aspects,the main indications,limitations and clinical results of the transjugular intrahepatic portosystemic shunt(TIPS)in portal hypertension(PH)are addressed.With the emergence of the coated prosthesis,a better shunt patency,a lower incidence of hepatic encephalopathy(HE)and better survival when compared to TIPS with the conventional prosthesis are demonstrated.The main indications for TIPS are refractory ascites,acute variceal bleeding unresponsive to pharmacological/endoscopic therapy and,lastly,patients considered at high risk for rebleeding preemptive TIPS(pTIPS).Absolute contraindications to the use of TIPS are severe uncontrolled HE,systemic infection or sepsis,congestive heart failure,severe pulmonary arterial hypertension,and biliary obstruction.The control of hemorrhage due to variceal rupture can reach up to 90%-100%of cases,and 55%in refractory ascites.Despite evidences regarding pTIPS in patients at high risk for rebleeding,less than 20%of eligible patients are treated.TIPS may also decrease the incidence of future decompensation in cirrhosis and increase survival in selected patients.In conclusion,TIPS is an essential treatment for patients with PH,but is often neglected.It is important for the hepatologist to form a multidisciplinary team,in which the role of the radiologist with experience in interventional procedures is prominent.展开更多
A recent study in World Journal of Hepatology examined the use of intravascular ultrasound(IVUS)for transjugular intrahepatic portosystemic shunt(TIPS)creation.The study concluded that IVUS significantly reduces proce...A recent study in World Journal of Hepatology examined the use of intravascular ultrasound(IVUS)for transjugular intrahepatic portosystemic shunt(TIPS)creation.The study concluded that IVUS significantly reduces procedure time,radiation exposure,and the number of needle passes compared to conventional fluoroscopic guidance.IVUS offers real-time visualization of the portal vein,but challenges remain in terms of equipment costs and the operator learning curve.TIPS creation techniques vary widely in clinical practice,where methods,such as conventional fluoroscopy,three-dimensional image fusion,electromagnetic navigation,and IVUS,are commonly employed.In this editorial,we provide a comparative analysis of these methods based on clinical experience and the literature.By evaluating the strengths and limitations of each technique,we aim to inform clinical decision-making and enhance procedural outcomes.Future developments in TIPS creation are likely to focus on hybrid techniques that combine the strengths of IVUS,electromagnetic navigation,and real-time image fusion,potentially leading to more precise,cost-effective,and accessible methods.展开更多
Patent foramen ovale(PFO)is a common congenital heart disorder associated with stroke,decompression sickness and migraine.Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiograp...Patent foramen ovale(PFO)is a common congenital heart disorder associated with stroke,decompression sickness and migraine.Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiography has important clinical significance and can improve the accuracy of detecting right-left shunts(RLSs)in patients with PFO.In this letter,regarding an original study presented by Yao et al,we present our insights and discuss how to better help clinicians evaluate changes in PFO-related RLS.展开更多
BACKGROUND Early transjugular intrahepatic portosystemic shunts(TIPS)is a therapeutic option for acute variceal bleeding(AVB),offering a low risk of rebleeding.However,the long-term outcomes of early TIPS remain uncle...BACKGROUND Early transjugular intrahepatic portosystemic shunts(TIPS)is a therapeutic option for acute variceal bleeding(AVB),offering a low risk of rebleeding.However,the long-term outcomes of early TIPS remain unclear.AIM To evaluate the long-term outcomes for early TIPS compared with standard treatment in patients with cirrhosis and AVB.METHODS We retrospectively analyzed the clinical data of patients with AVB who underwent early TIPS or standard treatment between January 2014 and December 2023.The primary outcome was overall survival(OS).RESULTS A total of 37 patients with AVB underwent early TIPS,while 65 patients received standard treatment.Compared with the standard treatment group,the rates of uncontrolled bleeding or rebleeding in the early TIPS group were significantly lower(10.8%vs 50.8%,P<0.001).Over a median follow-up of 46 months,no statistically significant differences were observed in terms of OS(P=0.507).The presence of comorbidities was identified as an independent predictor of OS(adjusted hazard ratio=3.81;95%confidence interval:1.16-12.46).Notably,new or worsening ascites occurred less frequently in the early TIPS group(13.5%vs 38.5%,P=0.008).There was no significant difference in the rate of overt hepatic encephalopathy between the two groups(45.9%vs 36.9%,P=0.372).CONCLUSION While early TIPS is not associated with a long-term survival benefit compared with standard treatment for AVB,it is associated with reduced risks of rebleeding and ascites.展开更多
文摘Background: Lumboperitoneal (LP) shunts have been used to manage benign intracranial hypertension (BIH) for an extended period. While they may swiftly and effectively alleviate symptoms, their application is accompanied by potential complications. Objectives: This research aimed to retrospectively analyze the difficulties and complications related to LP shunt implantation. Methods: We conducted a retrospective analysis of the records of 47 patients who had LP shunt placement for the treatment of BIH at our hospital throughout the research period. A thorough history and physical examination were conducted in every case. All patients were asked about age, gender, body mass index, neurological history, and oral contraceptive usage. Post-operative complications, clinical and ophthalmological follow-up occurred at 1, 3, and 6 months post-op. Results: Patients were mostly women (93.6%). The mean age of the patients was 35, and 80.9 percent had BMIs exceeding 25. Many female patients (40.9%) used oral contraceptives. Nearly all patients (93.6%) reported decreased vision, and 87.2% suffered headaches. The most common issue was shunt obstruction (51%), followed by low tension headaches (63.8%). The peritoneal side (10.6%) had higher shunt slippage than the thecal (2.1%). Superficial infections and radiculopathy affected 10.6% of patients, whereas CNS infections, arachnoiditis, and shunt failure affected just 2.1%. Five patients (10.6%) had Chiari malformation, and 60% had syringomyelia. Conclusion: Using LP shunts to treat BIH seems to be a method devoid of major risks despite the high revision rates. At the same time, more severe complications such as CNS infections, arachnoiditis, and shunt failure were less common.
文摘BACKGROUND The use of intravascular ultrasound(iUS)has been shown in multiple singlecenter retrospective studies to decrease procedure time,radiation exposure,and needle passes compared to conventional fluoroscopic guidance in the creation of a transjugular intrahepatic portosystemic shunt(TIPS).However,there are few data regarding the impact of imaging guidance modality choice on clinical outcomes.AIM To determine the impact of iUS vs fluoroscopic guidance during creation of a TIPS on procedural metrics,liver injury,shunt patency and mortality.METHODS The retrospective study cohort consisted of 66 patients who underwent TIPS creation using iUS[“iUS-guided TIPS(iTIPS)group”]and 135 patients who underwent TIPS creation using fluoroscopic guidance[“conventional fluoroscopic-guided TIPS(cTIPS)group”]at 2 tertiary academic medical centers from 2015-2019.TIPS that required variceal embolization or portal vein recanalization were excluded.RESULTS The technical success rate was 100%in the iTIPS group and 96%in the cTIPS group(P=0.17).The iTIPS group had an air kerma(266±254 mGy vs 1235±1049 mGy,P<0.00001),dose area product(5728±6518 uGy×m^(2) vs 28969±19067 uGy×m^(2),P<0.00001),fluoroscopy time(18.7±9.6 minutes vs 32.3±19.0 minutes,P<0.00001),and total procedure time(93±40 minutes vs 110±51 minutes,P=0.01)which were significantly lower than the cTIPS group.There was no significant difference in liver function test adverse event grade at 1 month.With a median follow-up of 26 months(inter quartile range:6-61 months),there was no difference between the two groups in terms of thrombosis-free survival(P=0.23),intervention-free survival(P=0.29),or patient mortality(P=0.61).CONCLUSION The use of iUS in the creation of TIPS reduces radiation exposure and procedure time compared with fluoroscopic guidance.At midterm follow-up,the imaging guidance modality did not affect shunt patency or mortality.
文摘BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an established treatment for PH-related complications,including refractory ascites,variceal bleeding,hepatic hydrothorax and Budd-Chiari syndrome.However,post-TIPS cardiac decompensation has been reported in up to 25%of patients,often due to haemodynamic shifts revealing occult cardiac dysfunction.Current approaches to pre-procedural cardiac assessment and risk stratification remain inconsistent.This systematic review examines current recommendations and emerging strategies for cardiovascular evaluation in patients with cirrhosis prior to a TIPS.AIM To identify the key predictive factors for cardiac decompensation following a TIPS in patients with cirrhosis.METHODS A systematic review of available literature,using PubMed(including MEDLINE),Embase and Cochrane databases.Results were searched comprehensively,without exclusion criteria,from inception to May 2025.Given the predominance of retrospective cohort studies,risk of bias assessment was primarily performed using the ROBINS-E tool.RESULTS Thirteen studies were included(n=1674 patients),with a pulled mean decompensation rate of 8.8%.Due to the variability in TIPS timing,study quality and heterogeneity,a meta-analysis was not feasible,therefore results were synthesised narratively.Multiple diastolic dysfunction parameters independently and integrated through the American Society of Echocardiography guidelines demonstrated predictive value.Newly validated risk score,heart failure with preserved ejection fraction,and biomarkers such as N-terminal pro-B-type natriuretic peptide≥125 pg/mL consistently highlight cardiac dysfunction amongst the literature.Our review also explored left-atrial strain imaging as well as recent advances in cardiac magnetic resonance imaging and potential genetic contributors.CONCLUSION Multiple predictors of cardiac decompensation following TIPS exist,however studies are of limited quality.Implementing reliable markers may enable early risk stratification,candidate selection and guide pre-procedural optimisation.
基金Supported by Clinical Research Center for Hepatopathy and Intestinal Diseases of Fujian Province,No.2023GBYJ-YL-1.
文摘In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and treatment.By comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy group.The gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome therapies.Furthermore,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated PH.Despite these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal models.In conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.
文摘Objective:To investigate the usefulness of the descending aortic retrograde flow area to forward flow area(dAO RF)ratio using echocardiography in managing pulmonary blood flow during the perioperative period following Blalock-Thomas-Taussig shunt(BTTS)surgery.Methods:This retrospective study analyzed patient characteristics,surgical procedures,and perioperative courses.The dAO RF ratio was measured upon admission to the pediatric intensive care unit(PICU)and 12,24,48,and 72 h post-surgery.Blood pressure,percutaneous oxygen saturation,arterial blood gas values,and lactate levels were measured at the same time as the dAO RF ratio.Results:Seventy-one cases were analyzed.Excessive and low pulmonary blood flow occurred in 17 and two patients,respectively.Four patients required resuscitation within 72 h post-surgery,due to excessive pulmonary blood flow.No deaths occurred within 72 h.The dAO RF ratio was significantly higher in patients with excessive pulmonary blood flow at PICU admission and at its maximum(p=0.049 and p<0.01,respectively).The maximum dAO RF ratio was significantly correlated with lactate levels when measured concurrently;however,there was clinical variability in the resuscitation cases.The dAO RF ratio cutoff of 0.61 was highly accurate(area under the receiver operating characteristic curve:0.91[95%confidence interval:0.82-1.00]),sensitive(82.4%),and specific(94.4%)for detecting excessive pulmonary blood flow.Conclusions:Measuring the dAO RF ratio postoperatively can prevent deterioration in patients with BTTS by accurately detecting excessive pulmonary blood flow,offering a minimally invasive and accurate assessment of perioperative pathophysiology.
基金Chongqing Medical University Program for Youth Innovation in Future Medicine(W0204)Natural Science Foundation Project of Chongqing,Chongqing Science and Technology Commission(CSTB2023NSCQ-BHX0010)+1 种基金Chongqing Postdoctoral Research Project Special Support(2023CQBSHTB3074)Science and Technology Research Program of Chongqing Municipal Education Commission(KJQN202400421).
文摘Background Pulmonary arterial hypertension (PAH) is a progressive condition with a poorprognosis in children. Lung transplantation (Ltx) remains the ultimate option when patients are refractory toPAH-speciffc therapy. Reverse Potts shunt (RPS) has been introduced to treat suprasystemic PAH. This studyaims to investigate the clinical outcomes of suprasystemic PAH in children. Methods Embase, Pubmed,and the Cochrane Library databases were searched for related studies that reported the clinical outcomes ofsuprasystemic PAH following RPS in children. To investigate the clinical outcomes of RPS, meta-analyses ofthe early and overall mortalities were performed. Results Nine studies were included in this study. Theestimated early mortality was 14.4% (95% CI, 7.1% to 23.1%), and the overall mortality/Ltx was 23.2% (95%CI, 14.4% to 32.9%). The estimated 1-year survival was 86.3% (95% CI, 75.9% to 88.7%). A qualitative reviewshowed that the median value of 5-year survival free from Ltx of patients undergoing RPS was 68.6% (range:65% to 92.3%). Compared to Ltx, RPS did not signiffcantly increase the early mortality (OR, 2.48, 95% CI0.75 to 8.24, p = 0.14). RPS also signiffcantly improved the New York Heart Association/World HealthOrganization functional class, reduced the BNP/NT-pro BNP levels, decreased the PAH-speciffc therapy,and increased the six-minute-walking distance. Conclusions RPS may serve as an alternative treatmentfor suprasystemic drug-refractory PAH. Further large-scale and prospective cohort studies are needed tovalidate these ffndings.
基金approved by Chungbuk National University Hospital Institutional Review Board in Cheongju,Chugbuk,South Korea(No.CBNUH2022-09-013-HE001).
文摘BACKGROUND Hepatic encephalopathy(HE)affects more than 30%of patients with cirrhosis.Extrahepatic portosystemic shunt(EHPSS)has been suggested to be a contributing factor to HE recurrence and mortality.Therefore,early detection and intervention in EHPSS may improve patient outcomes.AIM To evaluate the effects of shunt embolization on mortality and HE recurrence.METHODS In this retrospective case-control study,16 cirrhotic patients with HE treated at a tertiary care center from January 2012 to August 2022 were included.Outcomes in eight patients who underwent embolization of EHPSS were compared with those in eight patients receiving standard care without embolization.Data on baseline characteristics,HE recurrence,and overall survival were collected and analyzed using Kaplan-Meier and log-rank tests.RESULTS Baseline characteristics were comparable between the groups.The 1-year overall survival rate was significantly higher in the treatment group(0.50)than in the control group(0.33).The HE recurrence-free rate was also higher in the treatment group(1.00)than in the control group(0.17).The median survival duration was longer in the treatment group{not reached[95%confidence interval(CI):23.84 to not available(NA)]}than in the control group[15.02 months(95%CI:9.86 to NA)](P=0.006).Similarly,the recurrence-free duration was longer in the treatment group[63.09 months(95%CI:63.09 to NA)]than in the control group[9.21 months(95%CI:4.47 to NA)](P=0.006).EHPSS embolization significantly reduced 1-year HE recurrence(hazard ratio=0.09;95%CI:0.01-0.75;P=0.026).CONCLUSION EHPSS embolization significantly improves 1-year survival and prevents recurrence of HE in cirrhotic patients.Routine computed tomography and early embolization are clinically beneficial.
文摘BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incidence post-TIPS across various groups and the prophylactic efficacies of various medications.METHODS A thorough literature search was performed in PubMed,Web of Science,EMBASE,and the Cochrane Library databases from their inception to November 24,2024,to collect data regarding HE incidence.The main outcome was HE incidence post-TIPS.A meta-analysis using a random effects model was performed to obtain odds ratios(ORs)and 95%confidence intervals.Statistical analyses were conducted using Stata and RevMan software.RESULTS This meta-analysis included nine studies with 1140 patients;647 received pharmacological agents including lactulose,rifaximin,albumin,and l-ornithin-l-aspartate,and 493 did not(controls).(1)In the single-group meta-analysis,the control group had higher short-and long-term HE rates than the drug intervention group.Among patients with and without prior HE,the non-intervention group's HE rates were also higher;(2)Pharmacological prevention post-TIPS significantly reduced HE incidence[OR=0.59(0.45,0.77),P=0.0001].Compared with the no prophylaxis,rifaximin reduced the risk of HE after TIPS[OR=0.52(0.29,0.95),P=0.03],but lactulose did not;(3)In patients without prior HE,pharmacological prevention significantly reduced post-TIPS HE incidence[OR=0.62(0.41,0.95),P=0.03];and(4)Network meta-analysis showed no significant differences among five prevention strategies.CONCLUSION The HE incidence after TIPS was relatively high,and the use of drugs after TIPS may reduce the HE incidence.However,research,especially large-scale randomized controlled trials,is still lacking.
文摘BACKGROUND Heart failure(HF),especially in patients with preserved ejection fraction and midrange ejection fraction,remains a significant global health burden.Interatrial shunt devices(IASDs),which allow blood flow from the left to the right atrium,offer a novel treatment approach by reducing left atrial pressure and alleviating symptoms.AIM To evaluate the efficacy and safety of IASDs in patients with HF through a systematic review and meta-analysis.METHODS We performed a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines,analyzing studies up to April 2025.Randomized controlled trials and observational studies comparing interatrial shunt therapy with control groups were included.Data on clinical outcomes were analyzed using Review Manager software.RESULTS Nine studies involving 1689 patients were included.IASDs significantly improved cardiac output[mean difference(MD):0.72,95%CI:0.13-1.32,P=0.02],right atrial pressure(RAP)(MD:0.70,95%CI:0.14-1.26,P=0.01),and 6-minute walk distance(MD:71.63,95%CI:24.13-119.13,P=0.003).There were no significant differences in major adverse cardiac events,myocardial infarction,ischemic stroke,or new-onset atrial fibrillation.However,all-cause mortality[risk ratio(RR):1.49,95%CI:1.02-2.18,P=0.04]and cardiovascular death(RR:1.66,95%CI:1.01-2.74,P=0.05)were significantly higher in the shunt group.CONCLUSION IASDs offer significant short-term improvements in cardiac output,RAP,and exercise capacity in HF patients.However,long-term safety concerns,particularly regarding mortality,necessitate further research and careful patient selection.
文摘Since the beginning of the 20th century,alkaline electrolysis has been used as a proven method for producing hydrogen on a megawatt scale.The existence of parasitic shunt currents in alkaline water electrolysis,which is utilized to produce clean hydrogen,is investigated in this work.Analysis has been done on a 20-cell stack.Steel end plates,bipolar plates,and an electrolyte concentration of 6 M potassium hydroxide are all included in the model.The Butler-Volmer kinetics equations are used to simulate the electrode surfaces.Ohmic losses are taken into consideration in both the electrode and electrolyte phases,although mass transport constraints in the gas phase are not.Using an auxiliary sweep to solve equations,the model maintains an isothermal condition at 85℃ while adjusting the average cell voltage between 1.3 and 1.8 V.The results show that lower shunt currents in the outlet channels as opposed to the intake channels are the result of the electrolyte’s lower effective conductivity in the upper channels,which is brought on by a lower volume fraction of the electrolyte.Additionally,it has been seen that the shunt currents intensify as the stack gets closer to the conclusion.Efficiency is calculated by dividing the maximum energy output(per unit of time)that a fuel cell operating under comparable conditions might produce by the electrical energy needed to generate that output inside the stack.At first,energy efficiency increases due to the rise in coulombic efficiency,peaking around 1400 mA.The subsequent decline after reaching 1400 mA is linked to an increase in stack voltage at elevated current levels.
文摘The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic shunt(TIPS).Both treatment modalities have demonstrated efficacy;however,each presents distinct challenges and benefits.NSBBs,including propranolol,nadolol,and carvedilol,effectively reduce portal pressure,but are associated with side effects such as bradycardia,hypotension,fatigue,and respiratory issues.Additionally,NSBBs can exacerbate conditions such as refractory ascites,hepatorenal syndrome,and hepatic encephalopathy.In contrast,TIPS effectively reduces the incidence of variceal rebleeding,controlling refractory ascites.However,it is associated with a significant risk of hepatic encephalopathy,shunt dysfunction,and procedurerelated complications including bleeding and infection.The high cost of TIPS,along with the need for regular follow-up and potential re-intervention,poses additional challenges.Furthermore,patient selection for TIPS is critical,as inappropriate candidates may experience suboptimal outcomes.Future studies comparing NSBBs and TIPS should focus on refining the patient selection criteria,enhancing procedural techniques,optimising combination therapies,and conducting long-term outcome studies.Personalised treatment approaches,costeffectiveness analyses,and improved patient education and support are essential for maximising the use of these therapies.
基金Supported by Hefei Natural Science Foundation,No.202341.
文摘Transjugular intrahepatic portosystemic shunt(TIPS)is widely used to treat portal hypertension and its complications patients with cirrhosis.However,managing post-TIPS hepatic encephalopathy(HE)remains a major clinical challenge.HE is characterized by a high incidence and a complex pathogenesis,influenced by various factors.Therefore,careful patient assessment and selection for TIPS is essential.While previous studies have identified several factors contributing to the occurrence of post-TIPS HE,there is a gap in the comprehen-sive integration of surgical procedural parameters and metabolic mechanisms within a multidimensional analysis.This minireview aims to optimize treatment protocols and refine management strategies by conducting a comprehensive analysis of risk factors,ultimately aiming to reduce the incidence of post-TIPS HE.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentially serious complication following TIPS creation.Timely identification and management are crucial for preventing further adverse events.CASE SUMMARY We report a 56-year-old male patient who underwent a TIPS procedure for re-current melena caused by portal hypertension secondary to hepatitis B and experienced a stent fracture 15 months post-procedure.He was readmitted 30 months after the initial TIPS due to recurrent esophagogastric variceal bleeding and ascites.An attempt to revise the dysfunctional shunt via a stent-in-stent approach was unsuccessful.Consequently,a parallel TIPS procedure was success-fully performed via the proximal end of the fractured stent to decompress the portal venous system.At the 1-month follow-up,the patient exhibited no recur-rent variceal bleeding,and his ascites had significantly decreased.Twelve-month postoperative monitoring revealed no hepatic encephalopathy and no recurrence of bleeding or ascites.Additionally,we review the existing literature on post-TIPS stent fractures to explore the underlying mechanisms contributing to this com-plication.CONCLUSION Early recognition and prompt intervention are essential in managing stent fractures after TIPS creation to mitigate potential risks and ensure optimal patient outcomes.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)has an important role in the therapy of complications of portal-hypertension-related ascites.Various guidelines now indicate that TIPS is indicated for refractory ascites(RA),but TIPS for recurrent nonrefractory ascites(RNRA)achieved better clinical results.AIM To compare the clinical outcomes of TIPS for RA and RNRA in patients with complications related to portal hypertension.METHODS There were 863 patients divided into two main categories who underwent TIPS between September 2016 and September 2021.In category 1,patients had ascites without cirrhotic gastrointestinal bleeding.The patients were divided into group A(RNRA,n=183)and group B(RA,n=217).In category 2,patients had ascites and cirrhotic gastrointestinal bleeding.The patients were divided into group C(RNRA,n=328)and group D(RA,n=135).The clinical outcomes were probability of total hepatic impairment,incidence of hepatic encephalopathy(HE)and mortality.RESULTS The symptoms of ascites disappeared or were relieved within 1 week in group A compared with group B(P=0.032),and in group C compared with group D(P=0.027).By the end of follow-up,there were significant differences in the rate of RA in group A compared with group B(P=0.016),and in group C compared with group D(P=0.012).The probability of total hepatic impairment was significantly different in group A compared with group B(P=0.024),and in group C compared with group D(P=0.019).The total incidence of HE was significantly different in group A compared with group B(P=0.008),and in group C compared with group D(P=0.004).The 6-month,and 1-,2-and 3-year survival rates were significantly different between groups A and B(all P<0.05),and between groups C and D(all P<0.05).CONCLUSION TIPS has a good therapeutic effect on ascites related to cirrhotic portal hypertension,and early TIPS for RNRA can prolong survival,and prevent progression to RA.
基金Supported by the“14th Five-Year”Talent Training Program of Beijing Shijitan Hospital,Capital Medical University,No.2023 LJRCLFQ.
文摘BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively reduces portal pressure,predicting long-term survival remains challenging due to the multifactorial nature of patient outcomes.Accurate survival prediction tools are lacking,and existing models often omit critical factors such as portal vein diameter.This study aimed to develop and validate a nomogram incorporating key clinical and biochemical variables to predict 1-year and 2-year survival following TIPS in PHT patients.We hypothesized that this model would provide improved risk stratification and guide clinical decisions.AIM To develop and validate a nomogram for predicting 1-year and 2-year survival in PHT patients post-TIPS.METHODS This retrospective cohort study included 848 TIPS-treated PHT patients with gastrointestinal bleeding from two tertiary hospitals(2013-2021).Mortality was the primary endpoint.Predictive variables were selected using least absolute shrinkage and selection operator regression,and a nomogram was developed with Cox regression to predict 1-year and 2-year survival.Model performance was evaluated through receiver operating characteristic curves,calibration plots,and decision curve analysis.RESULTS The mean age of the included(848)patients was 53.00 years±12.51,where 69.58%were men.Results showed that portal vein diameter,serum creatinine,potassium,and alpha-fetoprotein were the independent predictors of post-TIPS survival.Besides,the model showed strong discriminatory ability(C-index,0.816 in the training set;0.827 in the validation set)and good calibration.The area under the curve for 1-year and 2-year survival in the training set were 0.890[95%confidence interval(CI):0.802-0.948]and 0.838(95%CI:0.803-0.869),respectively.The area under the curve for 1-year and 2-year survival in the validation set were 0.934(95%CI:0.815-0.987)and 0.864(95%CI:0.811-0.907),respectively.CONCLUSION The developed nomogram could reliably predict 1-year and 2-year survival in patients undergoing TIPS for PHTinduced gastrointestinal bleeding.
基金Supported by the“14th Five-Year”Talent Training Program of Beijing Shijitan Hospital,Capital Medical University,No.2023 LJRCLFQ.
文摘BACKGROUND Portal hypertension(PHT),a complication of liver cirrhosis,is sometimes managed with transjugular intrahepatic portosystemic shunt(TIPS)to reduce portal pressure.Although effective,TIPS poses risks,including hepatic enceph-alopathy(HE).This study investigates whether a significant reduction in the portal pressure gradient(PPG)after TIPS improves outcomes in PHT patients.AIM To evaluate the impact of post-TIPS PPG reduction on clinical outcomes and explore the relationship between PPG reduction and portal vein diameter.METHODS This retrospective cohort study included 815 patients with PHT who underwent TIPS at two tertiary hospitals between 2014 and 2022.Patients were categorized based on whether they achieved a 50%reduction in PPG.Propensity score matching was applied to balance baseline characteristics.Kaplan-Meier analysis assessed clinical outcomes,including rebleeding,HE,liver failure,and hepato-cellular carcinoma.Cox regression identified risk factors,and Spearman correlation analyzed the relationship between PPG reduction and portal vein diameter.RESULTS Patients with a PPG reduction>50%had significantly lower risks of rebleeding(P=0.004),shunt dysfunction(P=0.002),and mortality(P=0.024)compared to those with a PPG reduction≤50%.However,these patients faced higher risks of HE(P<0.001)and liver failure(P=0.003).A significant negative correlation was observed between the percentage of PPG reduction and portal vein diameter(ρ=-0.632,P<0.001),suggesting that patients with smaller portal vein diameters may achieve greater PPG reductions.CONCLUSION A significant PPG reduction following TIPS is associated with improved clinical outcomes,including reduced risks of rebleeding,shunt dysfunction,hepatocellular carcinoma,and mortality,though it increases HE and liver failure risks.The observed correlation between portal vein diameter and PPG reduction highlights the potential role of portal vein anatomy in predicting TIPS efficacy,warranting further investigation.
文摘This is a narrative review in which the advances in technical aspects,the main indications,limitations and clinical results of the transjugular intrahepatic portosystemic shunt(TIPS)in portal hypertension(PH)are addressed.With the emergence of the coated prosthesis,a better shunt patency,a lower incidence of hepatic encephalopathy(HE)and better survival when compared to TIPS with the conventional prosthesis are demonstrated.The main indications for TIPS are refractory ascites,acute variceal bleeding unresponsive to pharmacological/endoscopic therapy and,lastly,patients considered at high risk for rebleeding preemptive TIPS(pTIPS).Absolute contraindications to the use of TIPS are severe uncontrolled HE,systemic infection or sepsis,congestive heart failure,severe pulmonary arterial hypertension,and biliary obstruction.The control of hemorrhage due to variceal rupture can reach up to 90%-100%of cases,and 55%in refractory ascites.Despite evidences regarding pTIPS in patients at high risk for rebleeding,less than 20%of eligible patients are treated.TIPS may also decrease the incidence of future decompensation in cirrhosis and increase survival in selected patients.In conclusion,TIPS is an essential treatment for patients with PH,but is often neglected.It is important for the hepatologist to form a multidisciplinary team,in which the role of the radiologist with experience in interventional procedures is prominent.
基金Supported by National Natural Science Foundation of China,No.82330061The PUMC Graduate Curriculum Informatization Development Special Fund Project,No.2024YXX004The CAMS Initiative for Innovative Medicine,No.2021-I2M-1-015.
文摘A recent study in World Journal of Hepatology examined the use of intravascular ultrasound(IVUS)for transjugular intrahepatic portosystemic shunt(TIPS)creation.The study concluded that IVUS significantly reduces procedure time,radiation exposure,and the number of needle passes compared to conventional fluoroscopic guidance.IVUS offers real-time visualization of the portal vein,but challenges remain in terms of equipment costs and the operator learning curve.TIPS creation techniques vary widely in clinical practice,where methods,such as conventional fluoroscopy,three-dimensional image fusion,electromagnetic navigation,and IVUS,are commonly employed.In this editorial,we provide a comparative analysis of these methods based on clinical experience and the literature.By evaluating the strengths and limitations of each technique,we aim to inform clinical decision-making and enhance procedural outcomes.Future developments in TIPS creation are likely to focus on hybrid techniques that combine the strengths of IVUS,electromagnetic navigation,and real-time image fusion,potentially leading to more precise,cost-effective,and accessible methods.
文摘Patent foramen ovale(PFO)is a common congenital heart disorder associated with stroke,decompression sickness and migraine.Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiography has important clinical significance and can improve the accuracy of detecting right-left shunts(RLSs)in patients with PFO.In this letter,regarding an original study presented by Yao et al,we present our insights and discuss how to better help clinicians evaluate changes in PFO-related RLS.
基金Supported by the Natural Science Foundation of the Science and Technology Commission of Shanghai Municipality,No.23ZR1458300the Key Discipline Project of Shanghai Municipal Health System,No.2024ZDXK0004the Doctoral Innovation Talent Base Project for Diagnosis and Treatment of Chronic Liver Diseases,No.RCJD2021B02.
文摘BACKGROUND Early transjugular intrahepatic portosystemic shunts(TIPS)is a therapeutic option for acute variceal bleeding(AVB),offering a low risk of rebleeding.However,the long-term outcomes of early TIPS remain unclear.AIM To evaluate the long-term outcomes for early TIPS compared with standard treatment in patients with cirrhosis and AVB.METHODS We retrospectively analyzed the clinical data of patients with AVB who underwent early TIPS or standard treatment between January 2014 and December 2023.The primary outcome was overall survival(OS).RESULTS A total of 37 patients with AVB underwent early TIPS,while 65 patients received standard treatment.Compared with the standard treatment group,the rates of uncontrolled bleeding or rebleeding in the early TIPS group were significantly lower(10.8%vs 50.8%,P<0.001).Over a median follow-up of 46 months,no statistically significant differences were observed in terms of OS(P=0.507).The presence of comorbidities was identified as an independent predictor of OS(adjusted hazard ratio=3.81;95%confidence interval:1.16-12.46).Notably,new or worsening ascites occurred less frequently in the early TIPS group(13.5%vs 38.5%,P=0.008).There was no significant difference in the rate of overt hepatic encephalopathy between the two groups(45.9%vs 36.9%,P=0.372).CONCLUSION While early TIPS is not associated with a long-term survival benefit compared with standard treatment for AVB,it is associated with reduced risks of rebleeding and ascites.
