REVIEW  NEW PERSPECTIVES IN HEPATOLOGY: MANAGEMENT OF COMPLEX LIVER DISEASES 

Minerva Gastroenterology 2021 March;67(1):26-37

DOI: 10.23736/S2724-5985.20.02784-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Management of portal hypertension severe complications

Alberto ZANETTO ¹, Giulio BARBIERO ², Michele BATTISTEL ², Salvatore S. SCIARRONE ¹, Sarah SHALABY ¹, Monica PELLONE ¹, Sara BATTISTELLA ¹, Martina GAMBATO ¹, Giacomo GERMANI ¹, Francesco P. RUSSO ¹, Patrizia BURRA ¹, Marco SENZOLO ¹ ✉

¹ Unit of Gastroenterology and Multivisceral Transplant, Department of Surgery, Oncology, and Gastroenterology, University Hospital of Padua, Padua, Italy; ² Department of Medicine, Institute of Radiology, University Hospital of Padua, Padua, Italy

Portal hypertension is a clinical syndrome characterized by an increase in the portal pressure gradient, defined as the gradient between the portal vein at the site downstream of the site of obstruction and the inferior vena cava. The most frequent cause of portal hypertension is cirrhosis. In patients with cirrhosis, portal hypertension is the main driver of cirrhosis progression and development of hepatic decompensation (ascites, variceal hemorrhage and hepatic encephalopathy), which defines the transition from compensated to decompensated stage. In decompensated patients, treatments aim at lowering the risk of death by preventing further decompensation and/or development of acute-on-chronic liver failure. Decompensated patients often pose a complex challenge which typically requires a multidisciplinary approach. The aims of the present review were to discuss the current knowledge regarding interventional treatments for patients with portal hypertension complications as well as to highlight useful information to aid hepatologists in their clinical practice. Specifically, we discussed the indications and contraindications of transjugular intra-hepatic portosystemic shunt and for the treatment of gastro-esophageal variceal hemorrhage in patients with decompensated cirrhosis (first section); we reviewed the use of interventional treatments in patients with hepatic vein obstruction (Budd-Chiari Syndrome) and in those with portal vein thrombosis (second section); and we briefly comment on the most frequent applications of selective splenic embolization in patients with and without underlying cirrhosis (third section).

KEY WORDS: Portasystemic shunt, transjugular intrahepatic; Embolization, therapeutic; PVT; Cirrhosis