Cirrhosis/Portal Hypertension
Cirrhosis occurs when the liver accumulates damage over time. The liver can regenerate, but it also develops scarring/fibrosis. If there is too much scarring/fibrosis, the liver itself can malfunction in many ways.
From diagnosis of hepatitis or assessment of fibrosis with percutaneous or transjugular liver biopsy to treatment of ascites and varices with DIPS and TIPS, we Interventional Radiologists at HRA help manage liver dysfunction at every stage.
Portal Vein Recanalization/Stent Placement
There are many possible causes of portal vein narrowing or occlusion, including cirrhosis, cancer, and coagulation problems.
If the portal vein becomes narrow or occluded, it can result in liver dysfunction, build up of fluid in the chest or abdomen and/or varices - dilated veins in the esophagus, stomach, or other locations - which can bleed.
These problems can be treated by reopening the blockage. This can either be done via a transjugular approach with TIPS/DIPS creation or transhepatic approach. Then balloons and/or stents will be used to open up the narrowing and improve blood flow.
This procedure has a moderate risk of bleeding, infection, and damage to nearby organs. There is a small risk of technical failure and liver failure. These procedures can be performed on both inpatients and outpatients. All patients should refrain from eating and drinking for 6 hours prior to the procedure and will undergo general anesthesia (i.e. be put to sleep). Finally, all patients remain in the hospital overnight after their procedure.
Percutaneous liver Biopsy
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TIPS/DIPS Creation
If a patient has cirrhosis and portal hypertension or hepatic vein obstruction, they may develop buildup of fluid in their chest or abdomen or varices - dilated veins in their esophagus, stomach, or other locations - which can bleed.
These problems can be treated by creating a bypass between the portal vein, which brings blood into the liver, to the hepatic vein or inferior vena cava (IVC), which drains blood from the liver. Using x-ray and intravascular ultrasound guidance, a needle is advanced from the vein of the neck (jugular vein) into the hepatic vein or IVC. The needle is then advanced across a small portion of the liver into the portal vein. Pictures are taken to confirm location, pressures are measured to understand the severity of disease, and, eventually, a stent is placed from the portal vein, across the liver, into the hepatic vein or IVC. If there are any varices, we may block those veins off from the inside to prevent future bleeding.
This procedure has a moderate risk of bleeding, infection, and damage to nearby organs. There is a small risk of technical failure and liver failure. These procedures can be performed on both inpatients and outpatients. All patients should refrain from eating and drinking for 6 hours prior to the procedure and will undergo general anesthesia (i.e. be put to sleep). Finally, all patients remain in the hospital overnight after their procedure.
TIPS/DIPS Revision
After undergoing a TIPS or DIPS, the patient may have new or recurrent symptoms. Sometimes these symptoms are due to worsening liver disease. Sometimes they are due to the stent shunting too much blood from one side of the liver to the other. Most frequently, the symptoms are due to the stent starting to narrow or kink over time.
In any case, if a patient has a TIPS or a DIPS and recurrent symptoms, they may need to have their stent evaluated. This can sometimes be accomplished with ultrasound, CT, or MRI. Sometimes, however, it requires a venogram with reduction or venoplasty/stent placement.
This is done by using ultrasound to get into the vein of the neck (jugular vein). From there, a catheter is advanced through the veins of the chest into the veins of the liver and the stent. Pictures are taken and pressure are measured. Depending on the symptoms, we may do nothing, try to make the stent smaller, or try to open the stent up more with a balloon or another stent.
The procedure has a low risk of bleeding, infection, and damage to nearby organs. We typically perform this procedure on outpatients. All patients should refrain from eating and drinking for 6 hours prior to the procedure. Outpatients usually go home 1-3 hours after the procedure.
Transjugular Liver Biopsy
Many different diseases can cause liver inflammation. Blood work can help us discover liver inflammation and narrow down the cause of that inflammation, but often we require a small piece of the liver to learn the exact problem. Additionally, after inflammation occurs, the liver can regenerate and/or lay down scar tissue. A small piece of liver can help us assess how severe the inflammation was and how much scarring occurred.
There are two main ways to obtain a small piece of the liver. One is through the skin with ultrasound guidance. The other is by going through the vein of the neck (the jugular vein), through the veins of the chest, and into the veins of the liver. This second way lets us take pictures of the veins, measure their pressures to assess for portal hypertension - a complication of liver fibrosis - and obtain samples of the liver.
The procedure has a low risk of bleeding, infection, and damage to nearby organs. We typically perform this procedure for both inpatients and outpatients. All patients should refrain from eating and drinking for 6 hours prior to the procedure. Inpatients can return to their room after an hour of monitoring. Outpatients can go home 3 hours after the procedure.
