| Abstract [eng] |
The formation of transjugular intrahepatic portosystemic shunt is effective in managing severe complications of cirrhotic portal hypertension. Due to its impact on hemodynamics, careful consideration of contraindications is essential. The aim of this study is to analyze and review the scientific literature regarding the transjugular intrahepatic portosystemic shunt indications in cirrhotic portal hypertension and review the main contraindications, while illustrating it with a clinical case. Literature search was conducted in “PubMed“, “ScienceDirect“, “Google Scholar“ databases. 44 English language articles were analyzed. The review encompasses full-text articles, analyzed studies, narrative reviews, systematic reviews and meta-analyses. Descriptive analysis was used to analyze the sources. In patients with variceal bleeding transjugular intrahepatic portosystemic shunt is effective in preventing rebleeding, it also improves survival. It is superior to standard therapy in managing refractory ascites, it can be used for portal hypertensive gastropathy due to observed improvement in endoscopic lesions, reduced need for transfusions, for patients with hepatic hydrothorax because it reduces clinical signs, hepatorenal syndrome due to observed improvement in kidney function. Improvement in oxygenation have been observed in hepatopulmonary syndrome. Shunt use is limited by its effects on systemic hemodynamics. It can exacerbate heart failure, pulmonary hypertension. It is associated with higher incidence of hepatic encephalopathy. Poor liver function is linked to worse outcomes post-shunt. These conditions are the main contraindications. Before transjugular intrahepatic portosystemic shunt creation, it is essential to assess patient's general condition, conduct laboratory and imaging tests, rule out contraindications. |
