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Abstract Details
North American Practice-Based Recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension
1Division of Gastroenterology and Hepatology, Department of Medicine, Chicago, Illinois.
2Division of Vascular and Interventional Radiology, Department of Radiology, Chicago, Illinois.
3Division of Gastroenterology, Department of Medicine, Baylor University Medical Center, Dallas, Texas.
4Division of Gastroenterology and Hepatology, Department of Medicine, Banner-University Medical Center Phoenix, Phoenix, Arizona.
5Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, New York.
6Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
7Division of Digestive and Liver Diseases, New York, New York.
8Division of Gastroenterology, Liver Unit, University of Alberta, Edmonton, Alberta, Canada.
9Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
10Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Central Virginia Veterans Healthcare System, Richmond, Virginia.
11Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington Medical Center, Seattle, Washington.
12Division of Interventional Radiology, Department of Radiology, Washington University School of Medicine, St. Louis, Missouri.
13Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
14Dotter Department of Interventional Radiology, Portland, Oregon.
15Department of Digestive Diseases, Veterans Administration-Connecticut Healthcare System, New Haven, Connecticut.
16Division of Cardiology, Department of Internal Medicine, Dallas, Texas.
17Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona.
18Division of Gastroenterology and Hepatology, Department of Pulmonary and Critical Care Medicine, Rochester, Minnesota.
19Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.
20Division of Interventional Radiology, Department of Radiology, University of California-Los Angeles David Geffen School of Medicine, Los Angeles, California.
21Division of Transplantation, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
22Division of Nephrology and Hypertension, Department of Medicine, University of Southern California, Los Angeles, California.
23Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, Virginia.
24Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon.
25Division of Interventional Radiology, Department of Radiology, Dallas, Texas.
26Division of Gastroenterology and Hepatology, Department of Physiology, Mayo Clinic, Rochester, Minnesota.
27Division of Interventional Radiology, Department of Radiology, Columbia University Irving Medical Center, New York, New York.
28Division of Gastroenterology and Hepatology, Department of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: lvw@northwestern.edu.
Abstract
Complications of portal hypertension, including ascites, gastrointestinal bleeding, hepatic hydrothorax, and hepatic encephalopathy, are associated with significant morbidity and mortality. Despite few high-quality randomized controlled trials to guide therapeutic decisions, transjugular intrahepatic portosystemic shunt (TIPS) creation has emerged as a crucial therapeutic option to treat complications of portal hypertension. In North America, the decision to perform TIPS involves gastroenterologists, hepatologists, and interventional radiologists, but TIPS creation is performed by interventional radiologists. This is in contrast to other parts of the world where TIPS creation is performed primarily by hepatologists. Thus, the successful use of TIPS in North America is dependent on a multidisciplinary approach and technical expertise, so as to optimize outcomes. Recently, new procedural techniques, TIPS stent technology, and indications for TIPS have emerged. As a result, practices and outcomes vary greatly across institutions and significant knowledge gaps exist. In this consensus statement, the Advancing Liver Therapeutic Approaches group critically reviews the application of TIPS in the management of portal hypertension. Advancing Liver Therapeutic Approaches convened a multidisciplinary group of North American experts from hepatology, interventional radiology, transplant surgery, nephrology, cardiology, pulmonology, and hematology to critically review existing literature and develop practice-based recommendations for the use of TIPS in patients with any cause of portal hypertension in terms of candidate selection, procedural best practices and, post-TIPS management; and to develop areas of consensus for TIPS indications and the prevention of complications. Finally, future research directions are identified related to TIPS for the management of portal hypertension.