Percutaneous transjugular portosystemic shunt

Article Abstract:

The portal vein carries blood to the liver. When disease blocks blood flow through the liver, pressure builds up, causing blood pressure in the vein to rise (portal hypertension). This in turn causes swelling and twisting of the portal vein (varices), and subsequent hemorrhage. Surgery to insert a shunt to lower pressure in the portal vein is the method with the lowest rate of renewed bleeding, but complications are many and mortality is high. In addition, improved long-term survival has not been demonstrated. A balloon expandable stent (tube to support the vein) introduced with a catheter inserted through the jugular vein (percutaneous transjugular intrahepatic portosystemic shunt, or TIPS) was developed to try to improve the outcome. TIPS was performed on eight patients, and was effective in controlling variceal hemorrhage. Ascites (accumulation of fluid in the abdomen) was reduced or completely resolved in the six patients who developed the condition. The stent moved out of place in one patient, but this was the only complication noted. One other patient had renewed bleeding, which was controlled by increasing the diameter of the shunt using angioplasty. The ability to enlarge the diameter of the shunt with a catheter after placement is a major advantage of this technique. Hospitalization after shunt placement ranged from one to 19 days, with an average of just over seven days. TIPS may also be useful in enabling patients with end-stage liver disease to survive longer while waiting for a transplant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Surgery, Portal hypertension

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Transjugular intrahepatic portosystemic shunt (TIPS): diagnostic and therapeutic technology assessment (DATTA)

Article Abstract:

The use of a transjugular intrahepatic portosystemic shunt (TIPS) appears to be effective in controlling bleeding associated with enlarged esophageal veins or arteries in patients with liver disease. TIPS reduces blood pressure in the portal vein in the liver and can be used when drugs fail to shrink the bleeding blood vessels. A questionnaire was mailed to 72 physician specialists, and 54 responded. The doctors considered TIPS, although relatively new, to be an established therapy for patients with severe liver disease. Medical literature on TIPS was reviewed. The procedure, which can be performed quickly, was technically effective in 96% of cases. Technical complications of the procedure included perforation of blood vessels, organs, kidney, gallbladder, ducts; dislocation of the stent; and liver capsule transversal. Kidney failure, heart attack, encephalopathy and bacterial infections also have resulted from the TIPS procedure.

Care and treatment

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Diagnostic and therapeutic technology assessment (DATTA)

Article Abstract:

The Ilizarov technique may be an effective and safe method for correcting bone deformities or for limb-lengthening procedures. This technique was invented by the Russian orthopedic surgeon Gavril Ilizarov in the 1950s and has been used with increasing popularity in the US since 1984. It involves four stages of treatment. The first stage consists of surgery to cut the bone and the three other stages involve a piece of orthopedic equipment called the Ilizarov device. The Ilizarov device uses thin wires, under tension, to hold the bone externally in place. The device can be adapted to over 600 configurations to provide a custom fit for each patient. The principle behind the device is that continual tension and stress stimulates physiological pathways involved in the formation of new bone. Complications that can occur using the Ilizarov techniques are easily treatable and can often be avoided by careful planning.

Bones, Abnormalities, Equipment and supplies, Orthopedic surgery, Musculoskeletal abnormalities, Fracture fixation, Fracture repair

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