Question

Enumerate the various interventional radiology (IR) procedures that can be performed in a patient with portal hypertension.

Hint:

TIPS is one of the most important IR procedures in portal hypertension, especially in controlling refractory variceal bleeding and reducing portal pressure.

Answer 1

The following interventional radiology procedures are commonly performed in patients with portal hypertension to manage complications like variceal bleeding, ascites, and portal vein thrombosis:
1. Transjugular Intrahepatic Portosystemic Shunt (TIPS): A procedure that creates a channel between the portal and hepatic veins, allowing blood to bypass the liver, reducing portal pressure.
2. Endovenous Laser Therapy (EVLT) or Sclerotherapy for Variceal Bleeding:
Minimally invasive techniques to manage varices, which are common complications of portal hypertension. EVLT uses laser energy, while sclerotherapy involves injecting a sclerosing agent.
3. Balloon-occluded Retrograde Transvenous Obliteration (BRTO):
Used for bleeding gastric varices, where a balloon is inserted to occlude the varices, and sclerosing agents are applied.
4. Transjugular Biopsy:
A biopsy technique used for liver biopsy in patients with portal hypertension, especially when traditional percutaneous biopsy is contraindicated.
5. Portal Vein Thrombosis (PVT) Management:
IR procedures like thrombolysis or thrombectomy are used to manage PVT in portal hypertension.