Patients with chronic liver diseases develop high blood pressure in the portal vein, the main blood vessel supplying the liver. The increased blood pressure in the portal vein causes complications typical of liver cirrhosis, such as gastrointestinal bleeding from gastroesophageal varices or due to congestive gastropathy, or the onset of ascites refractory to treatment with diuretics, which requires weekly hospital stays to perform evacuation paracenteses. Refractory ascites can become infected and cause what is known as spontaneous bacterial peritonitis. Many of these complications can be lethal: the mortality reported in literature varies between 30% and 50%.
The TIPS (transjugular intrahepatic portosystemic stent) is an interventional radiology procedure that involves placing an expandable metal prosthesis (stent) between the portal vein and the vena cava. This is done to reduce the blood pressure increase and the risk of complications related to portal hypertension. ISMETT is one of the centers in Italy with most experience with these procedures. ISMETT collaborates with other European centers, particularly with the Hospital Clinic of Barcelona, Spain and with the University of Vienna.
The main indications for which a TIPS is performed at ISMETT are: gastrointestinal bleeding from gastroesophageal varices, congestive gastropathy, or ectopic varices in cases of lack of response to traditional treatment with beta-blockers and/or endoscopic therapy; ascites refractory to treatment with diuretics; and the Budd-Chiari syndrome, a rare but very serious disease that affects young subjects with alterations of blood coagulation causing thrombosis of the hepatic veins. At ISMETT, the TIPS is also used to restore patency of the portal vein in patients with portal thrombosis.
Recent data from literature shows that for some of these diseases, the TIPS increases the survival rates compared to traditional treatments, and reduces the number of hospital admissions.