Vai trò của siêu âm trong can thiệp tạo shunt cửa chủ trong gan qua đường tĩnh mạch cảnh (tips)

VAITRO CUA SEU AN TRONG CAN THEP

TAO SHUNT CYA CHU TRONG GAN QUA
DUONG TINH MACH CANH (TPS)

TS.BS, TRAN QUANG LUC
KHOA CDHA BVDK TINH PHU THO

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THE ROLE OF ULTRASOUND IN
TRANSJUGULAR INTRAHEPATIC
PORTOSYSTEMIC SHUNT INTERVENTION

Tran Quang Luc «PhD, MD,
Radiology DepartmPehunTtho Provincial General Hospital

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Content

{Introduction of TIPS
2, Pre TIPS ultrasound screening

4, TIPS creation under ultrasound guided

4, Post TIPS ultrasound surveillance

Introduction

> Liver Cirrhosis Liver with cithosis

o Hight prevalence in VN 0

0 Causes:

* Alcohol

* Hepatitis BC

* Others (not common)

0 Consequences:

*Portal venous hypertension

* Hepatic encephalopathy
+ Liver falure
* Liver cancer

Introduction

* Hemorrhage from GE varices š

* Ascites a |

* Hepatopulmonary syndrome `

+ Hepatorenal syndrome \

+ Primary peritonitis World J Gastrointest Phar Ther, 2019: 10/4)

Introduction

» Treatment: mm

* Medications

+ Endoscopy procedures

+ Surgery

* Interventional Radiology:

> TIPS

> BRTO CARTOPARTO)

» PIVO

TPS

TIPS (Transjugula intrahepatic
portosystemic shunt}

* Creat a shunt from Portal vein to Hepatic
vein or IVC
*Blood flow travels through the shuntto
the right ventricle and stops going
through the varice

httos:/virelinic.com

TPS

> Indications (Baveno VIl- Renewing consensus in portal venous hypertention

||

Recurrent bleeding due to rupture of gastroesophgeal varices, that falure to
Control by endoscopy therapy
* Recurrent ascites (requiof 2r3 elamrgee«vnoltume paracentesis with4yieanr)
* Budd-Chian syndrome

(when hepatic vein angloplasty/stentingthrombectomlthrombolysis is not feasible
and when the patient does not improve on medical therapy including anticoagulants)

fopulmonary and Hepatorenal syndrome

TPS

procedure

Looy et WordJ Gastroenterol (2019, 19/37)

II)

screening

P0tellie ⁄ \ Post «TIPS

quiding a

Pre-TIPS US Screening

> Aim:

* Evaluatitohne liver morphology
Hepatic vessels:

0 Portal vein: dlameter, thrombosis (partial or complete, focal orcffuse, flow

(hepatopetal or hepatofugal)

0 Collateral velns

0 Hepatic veins

* Others: ascites, splenomegaly, pleural effusion...

Liver
morphology

Doppler:

Portal vein
Hepatic artery
Hepatic veins

Reversed flow in

portal vein and
splenic vein

(Hepatogugal)
Reversed flow in
the left gastric vein
Hepatogugal

C Gora, The Bish Journal of Radiology (2002), 75:914-929

Portal vin thrombosis;

Risk of TIPS creation difficulty
More adjuvant techniques
Han G (2040); successful rate 76%,

Velontin N (2018): successful rate 86,7"

Portal vein thrombosis;

Adjuvant technique: Transhepatic approach to main
portal vein angioplasty

Then TIPS creation

TIPS creation under US guidance

» Aim

+ | guided for jugulaverin approach

* Transabdominal US - guided forthe puncture from hepatic vein right
HV) to portal vein (right PV)

* Reduce the procedure time, radiation exposure and complications

»Patient and material preparation

» Patient and material preparation

TIPS creation steps