Hepatic-portal interventions

摘要

Major advances in the percutaneous management of hepatoportal venous disease and portal hypertension have been introduced in the past decade. These include catheter-directed thrombolysis, mechanical thrombectomy, embolization, recanalization, balloon angioplasty (percutaneous transluminal angioplasty (PTA)), stent placement, and transjugular intrahepatic portosystemic shunt (TIPS). TIPS has proved to be a safe and effective interventional radiological procedure for the treatment of acute variceal hemorrhage that is unresponsive to sclerotherapy, intractable ascites, and Budd-Chiari syndrome. In addition, it has largely replaced surgical shunt procedures. Recanalization and stenting can relieve hepatic outflow obstruction effectively in patients with Budd-Chiari syndrome. The transhepatic or transjugular approach allows for a variety of percutaneous radiologic interventions for occlusive portal vein diseases, including acute and chronic portal vein thrombosis and portal vein stenosis. The interventionalradiologist has played a major role in developing and advancing techniques that have the potential to replace many of the traditional medical and surgical treatments for a variety of occlusive disorders in the hepatic and portal veins and inferior vena cava.