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Portal Hypertension

Portal hypertension is a serious condition that can lead to internal bleeding, abdominal buildup and liver failure. While lifestyle changes and medication are helpful for some patients, others need minimally invasive procedures to stop and prevent complications. At Vascular and Interventional Partners in Scottsdale, AZ, our interventional radiologists are highly skilled and experienced in treating portal hypertension using minimally invasive techniques. Our longstanding affiliation with one of Arizona’s largest liver disease centers has made us regional experts in treating portal hypertension.

What Is Portal Hypertension?

The portal venous system is a network of blood vessels that brings blood from your digestive organs back to your liver. Hypertension is another way of referring to high blood pressure. So, portal hypertension is increased pressure in the portal vein system.

Portal hypertension often happens when blood cannot flow normally through the liver. Sometimes, this is related to scarring in the liver or other liver diseases. The increased pressure in the portal vein can cause formation of new enlarged veins that bypass the liver. These are called collateral vessels, or “portosystemic” collaterals.

One of the most common areas where these enlarged veins form is in the esophagus and stomach. These enlarged veins are called varices. Varices are thin and can bleed easily, which for some patients can even be life-threatening.

A second negative consequence of portal hypertension is fluid buildup. For many patients with portal hypertension, large amounts of fluid can collect in the abdominal cavity or chest cavity. In the abdominal cavity, this is called “ascites” and can require repeated drainage procedures. In the chest, fluid is called “pleural effusion” or “hepatic hydrothorax,” and also can require repeated drainage.

Another rare but potential complication of portal hypertension is also enlargement of the spleen. This can decrease the number of white blood cells and platelets, leading to an increased risk of infection and bleeding.

What is Portal Hypertension?

Causes of Portal Hypertension

There are two main causes of portal hypertension: cirrhosis and thrombosis.

The most common cause of portal hypertension is liver cirrhosis. Liver cirrhosis is scarring of the liver due to chronic liver injury from chronic hepatitis, alcohol abuse, non-alcoholic fatty liver disease, or autoimmune diseases. Scar tissue in the liver is the hallmark of cirrhosis, and can interfere with blood flow through the liver, slowing it down and causing increased portal venous pressure.

Thrombosis, another cause of portal hypertension, is the formation of a blood clot (thrombus) within a blood vessel. Blood clots in the portal vein or the hepatic veins can also lead to this condition. When a blood clot blocks the portal vein, it prevents normal flow through the liver. Portal vein thrombosis, however, is often a result of cirrhosis. A rare condition called Budd-Chiari syndrome can impact blood flow through the liver. Other causes include congestive heart failure and abnormalities of blood coagulation.

Signs & Symptoms

In most patients, portal hypertension does not cause any symptoms early on. However with time, many patients can develop symptoms or complications which include:

  • Black, tarry stools or red blood in stool
  • Vomiting blood
  • Upper abdominal pain
  • Ascites (abdominal fluid)
  • Pleural effusion (chest fluid)
  • Hepatic encephalopathy (confusion and poor memory)
  • Decreased platelet count

Although portal hypertension can be acute or chronic, there is no symptom time frame to distinguish between the two.

How Is Portal Hypertension Treated?

In most cases, treatment of portal hypertension is mainly focused on preventing and managing complications:

Endoscopic therapy

Endoscopic therapy refers to several treatments in which treatment is carried out via an endoscope. An endoscope is a flexible tube with a light camera that helps doctors look at your digestive organs without major incisions. These treatments, which include banding and sclerotherapy, help stop bleeding caused by varices.

Medications

Doctors may also prescribe drugs that reduce pressure in the varices and portal vein. These mostly include nonselective beta blockers. Patients with confusion due to hepatic encephalopathy are given lactulose, a synthetic sugar.

Interventional Procedures

Highly trained interventional radiologists can perform image-guided procedures to treat advanced portal hypertension, as described below.

Patients also need to make lifestyle changes to prevent worsening of portal hypertension and to improve liver functioning.

How to Treat Portal Hypertension

How We Treat Portal Hypertension

If conventional treatments fail to reduce portal hypertension, swelling and bleeding, patients may need to undergo decompression procedures. At Vascular and Interventional Partners in Scottsdale, AZ, we treat patients with portal hypertension in several ways. One procedure is a minimally invasive procedure called Transjugular Intrahepatic Portosystemic Shunt (TIPS). Another procedure is called Retrograde Transvenous Obliteration, which is a minimally invasive procedure done through the veins to shut down high-risk varices.

TIPS

TIPS is a procedure performed in the hospital, to connect the hepatic vein with the portal vein using a shunt placed in the middle of the liver. The hepatic vein is a blood vessel that directs blood away from the liver. Connecting this vein with the portal vein helps reroute blood flow in the liver to relieve pressure within the portal vein.

During a TIPS procedure, specialists like the doctors at ViP use X-ray and ultrasound imaging to guide a catheter from a vein in the neck to a vein in your liver. Once in the liver, a special tube called a stent is placed to connect the portal vein to a hepatic vein. At the end of this procedure, providers may check the portal vein pressure to make sure it has gone down.

TIPS can be a life-saving procedure that immediately relieves pressure within the portal vein to stop rapid gastrointestinal bleeding. The procedure can also help with abdominal swelling by decreasing the amount of fluid that builds up.

Benefits
vs
Risks

TIPS

Benefits of tips

For patients with complications due to portal hypertension, TIPS can offer many benefits:

  • No need for open surgery, large incisions, or stitches
  • Minimally invasive with quick recovery
  • Completed in as little as 60 to 90 minutes
  • Immediate results
  • Low risk of side effects and complications
  • Decreases amount of fluid building up in the chest and abdomen
  • Ability to stop GI bleeding
Risks of tips

Like any medical procedure, TIPS also comes with a certain level of risk. But when performed by skilled and experienced specialists, your chances of complications during and after your procedure are kept to a minimum. Nonetheless, patients need to be aware of the possibility of things going wrong. In general, the following risks have been reported in a small number of patients:

  • Bleeding
  • Direct injury to the liver
  • Hepatic encephalopathy (confusion)
  • Acute liver failure
  • Infection
Transvenous Obliteration treatment

Transvenous Obliteration

Transvenous Obliteration, sometimes called “BRTO” is a procedure performed in the hospital or an outpatient facility, to shut down flow in large veins called varices. Sometimes shutting down a vessel is referred to as an “embolization.” By shutting down these varices, we can decrease risk of bleeding, or drive more blood flow to the liver. Sometimes, this transvenous obliteration can happen in addition to a TIPS procedure.

Benefits
vs
Risks

Transvenous Obliteration

Benefits of Transvenous Obliteration

For patients with complications due to portal hypertension, transvenous obliteration can offer many benefits:

  • Decreased risk for current or future bleeding
  • Improvement in hepatic encephalopathy
  • No need for open surgery, large incisions, or stitches
  • Minimally invasive with quick recovery
  • Completed in as little as 60 minutes
  • Immediate results
  • Low risk of side effects and complications
Risks of Transvenous Obliteration

Like any medical procedure, transvenous obliteration or BRTO also comes with a certain level of risk. But when performed by skilled and experienced specialists, your chances of complications during and after your procedure are kept to a minimum. Nonetheless, patients need to be aware of the possibility of things going wrong. In general, the following risks have been reported in a small number of patients:

  • Bleeding
  • Unintended clotting in the veins
  • Nontarget embolization (material traveling to other blood vessels)
  • Infection
  • Access site bruising or bleeding

Why Choose Vascular and Interventional Partners?

Patients with portal hypertension often require immediate treatment of complications. In many cases, immediate intervention is needed to stop or prevent bleeding and swelling. For other patients, these procedures can be performed on an elective basis.

Our interventional radiologists have been specially trained to perform TIPS and Transvenous Obliteration on a wide range of patients with portal hypertension. In fact, we believe we have performed the largest number of these procedures in the entire southwest region over the last 10 years. Our physicians participate in academic research and large patient registries to study the outcomes of these procedures. Our expert doctors also train future physicians on how to perform the procedure safely and effectively.

At our private practice in Scottsdale, AZ, we make sure to be at the forefront of the latest innovations in interventional radiology to offer our patients the best care possible. To learn more about interventional radiology procedures for portal hypertension and how you can get treated at our facility, contact or call us today at (480) 435-9100.

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