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Liver and biliary system, pancreas and spleen
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Cirrhosis of the liver can result in increased pressure in the portal vein (portal hypertension). This can result in ascites or bleeding from varices. A TIPSS procedure shunts blood from the portal vein directly into the hepatic veins, bypassing the liver, to reduce portal pressure. It is performed through a jugular vein approach. A catheter is wedged into a very distal branch of a hepatic vein and contrast injected to reflux through the liver to opacify the portal vein. This is often performed using carbon dioxide (CO2) as the contrast agent as it refluxes more readily than iodinated contrast and provides better visualisation of the portal vein. CO2 angiography requires a system to inject the gas safely without introducing air and specific software for acquiring and post-processing the images. The image acquired is then used to guide passage of a needle from the hepatic vein into the portal vein. Once successful puncture of the portal vein is achieved, a stent is placed across the liver track between the portal and hepatic veins.
Diagnostic accuracy of liver stiffness on two-dimensional shear wave elastography for detecting clinically significant portal hypertension: a meta-analysis
Published in Expert Review of Medical Devices, 2023
Bingtian Dong, Yuping Chen, Yongjian Chen, Huaming Wang, Guorong Lyu
Portal hypertension (PH) is one of the primary consequences of liver fibrosis/cirrhosis [1], and it can lead to devastating clinical problems, especially formation of esophageal or gastric varices, variceal bleeding, and ascites, which may represent the most common cause of mortality in cirrhotic patients [2–4]. Traditionally, hepatic venous pressure gradient (HVPG) measurement is the gold standard to evaluate PH, with a HVPG ≥ 10 mmHg considered diagnostic for clinically significant portal hypertension (CSPH) [5,6]. However, HVPG is an invasive procedure with potential complications, and is not readily available and difficult to perform in routine medical institutions [7]. Recently, much effort has been devoted to develop an alternative, noninvasive tool for accurate detecting PH in order to avoid the invasiveness of HVPG in cirrhotic patients.