eMedicine Specialties > Radiology > Gastrointestinal

Portal Hypertension: Follow-up

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Coauthor(s): Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Murad Ali, MBBS, PhD, DTCD, Consulting Radiologist, Department of Radiology, Postgraduate Medical Institute, Lady Reading Hospital, Pakistan; David Sherlock, MBBS, FRCS, Consulting Staff, Department of Surgery, North Manchester General Hospital, Christie Hospital
Contributor Information and Disclosures

Updated: Feb 5, 2009

Intervention

Gastrointestinal bleeding from esophageal varices remains the most life-threatening condition resulting from portal hypertension. This is usually secondary to cirrhosis. The 30-day mortality rate approaches 30%, and rebleeding and death are common within 1 year. Surgery has failed to reduce the mortality rate. Endoscopic sclerotherapy has emerged as the most popular treatment. The goal is to arrest active bleeding by producing intravariceal thrombosis or extraluminal fibrosis around the varices. Various sclerosants are used.29

Percutaneous transhepatic coronary vein embolization is infrequently performed because of the high incidence of recurrent bleeding secondary to the development of new collaterals. Instead, most patients with variceal bleeding that is unresponsive to endoscopic sclerotherapy or banding undergo a TIPS procedure, during which the coronary vein may be embolized if gastroesophageal varices continue to fill after placement of a TIPS.

The technique used most often is percutaneous transhepatic portography (PTP) (see Angiography). The agent that provides the most effective long-term occlusion is large strips of compressed Gelfoam soaked in 3% sodium tetradecyl sulfate. The procedure may provide an alternative in arresting acute variceal bleeding that is not responsive to vasopressin or other medical methods. With transhepatic embolization, the patient's general status may improve enough to allow surgeons to perform elective shunt surgery.

Medicolegal Pitfalls

  • Percutaneous transhepatic portography (PTP) embolization of esophageal varices may have a complementary role with endoscopic sclerosis for the control of bleeding varices.
  • However, patients are extremely ill, and complications, if any, will exacerbate their condition.
  • It has been estimated that the incidence of pulmonary embolism following sclerotherapy treatment of bleeding could be as high as 6%; thus, careful postprocedural monitoring of patients is warranted.30
 


More on Portal Hypertension

Overview: Portal Hypertension
Imaging: Portal Hypertension
Follow-up: Portal Hypertension
Multimedia: Portal Hypertension
References
Further Reading
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References

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Keywords

portal hypertension, PH, portal HTN, portal venous pressure, hepatic venous pressure, portal venous flow, hematemesis, bleeding esophageal varices, portosystemic collateral vessels, portosystemic collaterals, cirrhosis, splenoportography

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Radiological Society of North America, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Murad Ali, MBBS, PhD, DTCD, Consulting Radiologist, Department of Radiology, Postgraduate Medical Institute, Lady Reading Hospital, Pakistan
Disclosure: Nothing to disclose.

David Sherlock, MBBS, FRCS, Consulting Staff, Department of Surgery, North Manchester General Hospital, Christie Hospital
Disclosure: Nothing to disclose.

Medical Editor

Eric P Weinberg, MD, Associate Professor, Department of Radiology, University of Rochester Medical Center, Strong Memorial Hospital
Eric P Weinberg, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

George Hartnell, MB, Professor of Radiology, Tufts University School of Medicine, Director of Cardiovascular and Interventional Radiology, Department of Radiology, Baystate Medical Center
George Hartnell, MB is a member of the following medical societies: American College of Cardiology, American College of Radiology, American Heart Association, Association of University Radiologists, British Institute of Radiology, British Medical Association, Massachusetts Medical Society, Radiological Society of North America, Royal College of Physicians, Royal College of Radiologists, and Society of Cardiovascular and Interventional Radiology
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Kyung J Cho, MD, FACR, William Martel Professor of Radiology, Interventional Radiology Fellowship Director, University of Michigan Health System
Kyung J Cho, MD, FACR is a member of the following medical societies: American College of Radiology, American Heart Association, American Medical Association, American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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