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Unsolved Questions in Salvage TIPSS: Practical Modalities for Placement, Alternative Therapeutics, and Long-Term Outcomes

Salvage transjugular intrahepatic portosystemic shunt (TIPSS) has proven its efficacy to treat refractory variceal bleeding for patients with cirrhosis. However, this procedure is associated with very poor outcomes. As it is used as a last resort to treat a severe complication of cirrhosis, it seems...

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Detalles Bibliográficos
Autores principales: Bouzbib, Charlotte, Sultanik, Philippe, Thabut, Dominique, Rudler, Marika
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463599/
https://www.ncbi.nlm.nih.gov/pubmed/31058111
http://dx.doi.org/10.1155/2019/7956717
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author Bouzbib, Charlotte
Sultanik, Philippe
Thabut, Dominique
Rudler, Marika
author_facet Bouzbib, Charlotte
Sultanik, Philippe
Thabut, Dominique
Rudler, Marika
author_sort Bouzbib, Charlotte
collection PubMed
description Salvage transjugular intrahepatic portosystemic shunt (TIPSS) has proven its efficacy to treat refractory variceal bleeding for patients with cirrhosis. However, this procedure is associated with very poor outcomes. As it is used as a last resort to treat a severe complication of cirrhosis, it seems essential to improve our practice, with the aim of optimizing management of those patients. Somehow, many questions are still unsolved: which stents should be used? Should a concomitant embolization be systematically considered? Is there any alternative therapeutic in case of recurrent bleeding despite TIPSS? What are the long-term outcomes on survival, liver transplantation, and hepatic encephalopathy after salvage TIPSS? Is this procedure futile in some patients? Is prognosis with salvage TIPSS nowadays as bad as earlier, despite the improvement of prophylaxis for variceal bleeding? The aim of this review is to summarize those data and to identify the lacking ones to guide further research on salvage TIPSS.
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spelling pubmed-64635992019-05-05 Unsolved Questions in Salvage TIPSS: Practical Modalities for Placement, Alternative Therapeutics, and Long-Term Outcomes Bouzbib, Charlotte Sultanik, Philippe Thabut, Dominique Rudler, Marika Can J Gastroenterol Hepatol Review Article Salvage transjugular intrahepatic portosystemic shunt (TIPSS) has proven its efficacy to treat refractory variceal bleeding for patients with cirrhosis. However, this procedure is associated with very poor outcomes. As it is used as a last resort to treat a severe complication of cirrhosis, it seems essential to improve our practice, with the aim of optimizing management of those patients. Somehow, many questions are still unsolved: which stents should be used? Should a concomitant embolization be systematically considered? Is there any alternative therapeutic in case of recurrent bleeding despite TIPSS? What are the long-term outcomes on survival, liver transplantation, and hepatic encephalopathy after salvage TIPSS? Is this procedure futile in some patients? Is prognosis with salvage TIPSS nowadays as bad as earlier, despite the improvement of prophylaxis for variceal bleeding? The aim of this review is to summarize those data and to identify the lacking ones to guide further research on salvage TIPSS. Hindawi 2019-04-01 /pmc/articles/PMC6463599/ /pubmed/31058111 http://dx.doi.org/10.1155/2019/7956717 Text en Copyright © 2019 Charlotte Bouzbib et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Bouzbib, Charlotte
Sultanik, Philippe
Thabut, Dominique
Rudler, Marika
Unsolved Questions in Salvage TIPSS: Practical Modalities for Placement, Alternative Therapeutics, and Long-Term Outcomes
title Unsolved Questions in Salvage TIPSS: Practical Modalities for Placement, Alternative Therapeutics, and Long-Term Outcomes
title_full Unsolved Questions in Salvage TIPSS: Practical Modalities for Placement, Alternative Therapeutics, and Long-Term Outcomes
title_fullStr Unsolved Questions in Salvage TIPSS: Practical Modalities for Placement, Alternative Therapeutics, and Long-Term Outcomes
title_full_unstemmed Unsolved Questions in Salvage TIPSS: Practical Modalities for Placement, Alternative Therapeutics, and Long-Term Outcomes
title_short Unsolved Questions in Salvage TIPSS: Practical Modalities for Placement, Alternative Therapeutics, and Long-Term Outcomes
title_sort unsolved questions in salvage tipss: practical modalities for placement, alternative therapeutics, and long-term outcomes
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463599/
https://www.ncbi.nlm.nih.gov/pubmed/31058111
http://dx.doi.org/10.1155/2019/7956717
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