Pandhi Mithil B, Kuei Andrew J, Lipnik Andrew J, Gaba Ron C
Department of Radiology, University of Illinois at Chicago, Chicago, Illinois.
Division of Interventional Radiology, University of Illinois at Chicago, Chicago, Illinois.
Semin Intervent Radiol. 2020 Mar;37(1):3-13. doi: 10.1055/s-0039-3402015. Epub 2020 Mar 4.
Emergent transjugular intrahepatic portosystemic shunt (TIPS) creation is most commonly employed in the setting of acute variceal hemorrhage. Given a propensity for decompensation, these patients often require a multidisciplinary, multimodal approach involving prompt diagnosis, pharmacologic therapy, and endoscopic intervention. While successful in the majority of cases, failure to medically control initial bleeding can prompt interventional radiology consultation for emergent portal decompression via TIPS creation. This article discusses TIPS creation in emergent, acute variceal hemorrhage, reviewing the natural history of gastroesophageal varices, presentation and diagnosis of acute variceal hemorrhage, pharmacologic therapy, endoscopic approaches, patient selection and risk stratification for TIPS, technical considerations for TIPS creation, adjunctive embolotherapy, and the role of salvage TIPS versus early TIPS in acute variceal hemorrhage.
急诊经颈静脉肝内门体分流术（TIPS）最常用于急性静脉曲张出血的情况。鉴于这些患者有失代偿的倾向，通常需要多学科、多模式的方法，包括及时诊断、药物治疗和内镜干预。虽然大多数情况下是成功的，但如果药物治疗未能控制初始出血，可能会促使介入放射科会诊，通过创建TIPS进行急诊门静脉减压。本文讨论了急诊急性静脉曲张出血时TIPS的创建，回顾了食管胃静脉曲张的自然病史、急性静脉曲张出血的表现和诊断、药物治疗、内镜方法、TIPS的患者选择和风险分层、TIPS创建的技术考虑、辅助栓塞治疗以及挽救性TIPS与早期TIPS在急性静脉曲张出血中的作用。
