Techniques in Vascular and Interventional Radiology最新文献

{"title":"Endoscopic Management of Portal Hypertension and Varices.","authors":"Samuel Tanner, Allison R Schulman","doi":"10.1016/j.tvir.2025.101053","DOIUrl":"https://doi.org/10.1016/j.tvir.2025.101053","url":null,"abstract":"<p><p>Chronic liver disease as well as various other conditions can change vascular resistance in the portal system thereby leading to portal hypertension. Acute gastroesophageal variceal bleeding is a dreaded complication of portal hypertension associated with high morbidity and mortality. Historically, endoscopy in the management of portal hypertension was limited to the prevention and treatment of esophageal varices. However, advancements in endoscopic-ultrasound techniques and availability of new devices have opened a new frontier in the management of gastric varices. Additionally, advancements in endoscopic techniques now allow for a more comprehensive diagnostic approach to portal hypertension. In this review, we summarize the role of endoscopy in the management of portal hypertension and varices.</p>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 3","pages":"101053"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatorenal Syndrome: Updates on Definition, Classification, Pathophysiology and Treatment Options.","authors":"Katherine Marchak, Davinder Singh, Maria Puello Barron, Premal Trivedi","doi":"10.1016/j.tvir.2025.101059","DOIUrl":"https://doi.org/10.1016/j.tvir.2025.101059","url":null,"abstract":"<p><p>Hepatorenal syndrome (HRS) is a severe complication of advanced liver disease, characterized by renal dysfunction in the absence of intrinsic kidney disease. It is associated with high mortality, necessitating early recognition and prompt treatment. In this review, we summarize the latest in pathophysiology, diagnosis, classification and treatment of hepatorenal syndrome relevant to a consulting interventional radiologist. The diagnosis and classification of HRS has recently been updated by the International Club of Ascites (ICA) and Kidney Disease Improving Global Outcomes (KDIGO) to include more subcategories that better reflect disease severity and prognosis. Greater insights have also been obtained into the pathophysiology of HRS, currently understood to be a complex manifestation of hemodynamic disturbances due to portal hypertension, systemic inflammation, oxidative stress, and biliary injury. We discuss the role of laboratory biomarkers in diagnosis and prognosis along with associated pitfalls. Treatment options are reviewed starting with first line medical management, adjunctive renal replacement therapy, and liver transplantation. Finally, we review the evidence to date investigating transjugular intrahepatic portosystemic shunt (TIPS) creation in this population, focusing on expected efficacy for specific subpopulations and current gaps in knowledge, all driving practical recommendations for when the procedure should be considered.</p>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 3","pages":"101059"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TIPS in Patients With Refractory Ascites: Review of Literature and Current Recommendations.","authors":"Matthew Abad-Santos, James Jeffries, Charles Hua, Guy E Johnson","doi":"10.1016/j.tvir.2025.101057","DOIUrl":"https://doi.org/10.1016/j.tvir.2025.101057","url":null,"abstract":"<p><p>In cirrhotic patients, refractory ascites (RA) is a devastating consequence of portal hypertension and is associated with high morbidity and mortality. Over the past quarter century, transjugular intrahepatic portosystemic shunt (TIPS) placement has become a key treatment for patients with RA, but there has been an evolution of patient evaluation, stents, and procedural techniques during this time. As such, the rates of ascites control, survival, and associated hepatic encephalopathy have evolved as well. This review examines the evidence and current recommendations for TIPS in the setting of RA.</p>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 3","pages":"101057"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Mesenteric and Portal Vein Thrombosis: Etiology, Diagnosis, and Interventional Management.","authors":"Divya Kumari","doi":"10.1016/j.tvir.2025.101058","DOIUrl":"https://doi.org/10.1016/j.tvir.2025.101058","url":null,"abstract":"<p><p>Acute portal and mesenteric vein thrombosis (PVT) can lead to fatal mesenteric ischemia, with mortality rates ranging from 37% to 76%. Early diagnosis and prompt venous revascularization are crucial in symptomatic cases. Spontaneous recanalization in portal vein thrombosis (PVT) is rare, making systemic anticoagulation the first-line treatment. However, even with early anticoagulation, recanalization occurs in only 35%-40% of cases. Involvement of the superior mesenteric vein (SMV) increases the risk of bowel ischemia, which is associated with poor outcomes. The primary goals of endovascular treatment for portomesenteric thrombectomy and lysis are to restore blood flow, prevent bowel ischemia, and reduce thrombus burden. This approach aims to alleviate symptoms, preserve liver and intestinal function, and facilitate anticoagulation while minimizing procedural risks. For patients who deteriorate despite anticoagulation, catheter-directed thrombolysis (CDT) via percutaneous transhepatic or transjugular access provides a safe and effective minimally invasive adjunctive treatment.</p>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 3","pages":"101058"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Morbidity and Mortality After Transjugular Intrahepatic Portosystemic Shunt Placement: A Review of Existing Models and Future Directions.","authors":"Moaz M Choudhary, Aria Nazeri, Amro S Aldine, Ankit R Mehta, Girish Kumar, Manoj K Kathuria, Shannan R Tujios, Arjmand R Mufti, Sanjeeva P Kalva","doi":"10.1016/j.tvir.2025.101062","DOIUrl":"https://doi.org/10.1016/j.tvir.2025.101062","url":null,"abstract":"<p><p>Transjugular intrahepatic portosystemic shunt (TIPS) is a key therapeutic intervention in the management of portal hypertension and its complications, such as variceal bleeding, hepatic hydrothorax, and refractory ascites. TIPS has historically been used as a lifesaving measure or as a bridge to liver transplantation (LT). Despite its efficacy, creation of a TIPS can be associated with significant morbidity, particularly in patients with decompensated cirrhosis. Complications include hepatic encephalopathy (HE), progressive liver dysfunction, and cardiovascular compromise. As such, accurate patient selection and risk stratification are essential to optimize clinical outcomes. This review synthesizes current evidence on predictive models for post-TIPS mortality. Traditional scoring systems such as the Child-Turcotte-Pugh (CTP) score and the Model for End-Stage Liver Disease (MELD) remain widely used, with newer iterations such as the MELD-Na and MELD 3.0 demonstrating improved prognostic accuracy. Notably, MELD 3.0 offers enhanced prediction of long-term mortality. In contrast, the Freiburg Index of Post-TIPS Survival (FIPS) has become a valuable tool for short-term mortality prediction. Additional models, including the Bilirubin-Platelet (Bili-PLT) score, offer further refinement. At the same time, the role of sarcopenia has gained attention as an independent and synergistic predictor of poor outcomes, especially when combined with MELD-based scores. Beyond mortality, this review explores the multifactorial pathophysiology of post-TIPS complications such as hepatic encephalopathy, liver failure, and right heart dysfunction that can cause significant morbidity. These outcomes are influenced by a spectrum of patient-related and procedural factors. Novel predictive approaches-encompassing clinical, radiological, and machine learning-based models-are being developed to better anticipate these risks.</p>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 3","pages":"101062"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transjugular Intrahepatic Portosystemic Shunt: Advanced Techniques and Complications.","authors":"Mamadou L Sanogo, Samuel J Magny, Hassan Anbari, Danielle Dobbs, Baljendra S Kapoor","doi":"10.1016/j.tvir.2025.101056","DOIUrl":"https://doi.org/10.1016/j.tvir.2025.101056","url":null,"abstract":"<p><p>The purpose of this manuscript is to review the indications, technical details, limitations, and complications of nonconventional techniques for transjugular intrahepatic portosystemic shunt creation. We describe alternative nonconventional techniques for TIPS creation when the conventional technique is unsuccessful.</p>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 3","pages":"101056"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Changes in Body Composition after Transjugular Intrahepatic Portosystemic Shunt Creation on Morbidity and Mortality: A Systematic Review.","authors":"Takeshi Suzuki, Khashayar Farsad","doi":"10.1016/j.tvir.2025.101060","DOIUrl":"10.1016/j.tvir.2025.101060","url":null,"abstract":"<p><p>Changes in body composition, including the reversal of sarcopenia, after transjugular intrahepatic portosystemic shunt (TIPS) creation have been reported to impact morbidity and mortality. This systematic review aims to identify changes in body composition that could serve as markers for post-TIPS outcomes in patients with cirrhosis. Electronic databases including Ovid Medline, Embase, and Central Register of Controlled Trials were searched from inception to February 5, 2025 to analyze the impact of changes in body composition on post-TIPS outcomes in patients with cirrhosis. A total of 16 studies were included in the review. Most studies reported that post-TIPS skeletal muscle gain often caused a reversal of sarcopenia (18%-66%) and contributed to improvements in morbidity and mortality. In particular, patients with pre-TIPS sarcopenia received the greatest benefit. Skeletal muscle index showed the most substantial increase within 6 months after TIPS creation, while the psoas muscle index or the transverse psoas muscle thickness/ height increased as early as 1-3 months after TIPS creation. Reversal of sarcopenia after TIPS creation may contribute to improvements in morbidity and mortality in cirrhosis. Skeletal muscle tends to show the most substantial increase within 6 months after TIPS creation, with the psoas muscle index observed as an early imaging biomarker. Further research is needed to identify the underlying physiologic mechanisms responsible for these observed body composition changes and to prospectively assess the impact on clinical outcomes.</p>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 3","pages":"101060"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Portal Vein Embolization: Efficacy, Methodology, and Alternatives.","authors":"Diana C Dinh, Muneeb Ahmed","doi":"10.1016/j.tvir.2025.101061","DOIUrl":"https://doi.org/10.1016/j.tvir.2025.101061","url":null,"abstract":"<p><p>Portal vein embolization (PVE) is a minimally invasive intervention that has become the standard of care in preoperative liver augmentation for patients undergoing extended hepatic resections for primary and secondary liver cancers. PVE provides permanent and complete occlusion of the portal venous inflow to diseased hepatic segments, re-directing portal flow to the future liver remnant and inducing hypertrophy sufficient to proceed to major hepatectomy. The aim of this review is to discuss the methods of identifying an insufficient future liver remnant, technical considerations for performing effective PVE, and the alternative/adjunctive measures for PVE.</p>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 3","pages":"101061"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preface.","authors":"","doi":"10.1016/j.tvir.2025.101051","DOIUrl":"https://doi.org/10.1016/j.tvir.2025.101051","url":null,"abstract":"","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 3","pages":"101051"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrahepatic Portosystemic Shunt (TIPS): Evolving Indications.","authors":"Tina Sankhla, Peter Park, Nick Swilley","doi":"10.1016/j.tvir.2025.101055","DOIUrl":"https://doi.org/10.1016/j.tvir.2025.101055","url":null,"abstract":"<p><p>Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure used to manage complications of portal hypertension, including most frequently refractory ascites and variceal bleeding. While TIPS has established indications, contraindications, and procedural guidelines, its scope is expanding with advancements in technology and improved evidence-based patient selection criteria. This article reviews the current indications and contraindications for TIPS, examines potential expanding applications, and discusses consensus guidelines from organizations such as the Society of Interventional Radiology (SIR), Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and American Association for the Study of Liver Diseases (AASLD).</p>","PeriodicalId":51613,"journal":{"name":"Techniques in Vascular and Interventional Radiology","volume":"28 3","pages":"101055"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}