The guidance, published in the journal Hepatology, provides practical indications for the use of endovascular therapies in the management of this liver complication. It was prepared by a panel of experts made up of specialists in hepatology, interventional hepatology, interventional radiology and surgery, based on a review of the published evidence in this field.
Oesophageal varices are enlarged veins in the oesophagus and occur in people with serious liver diseases with portal hypertension. These varices can bleed and this bleeding is one of the most severe complications in patients with liver disease due to the associated mortality. It is a medical emergency that requires urgent assessment and management.
The guidance first reviews the anatomy of the portosystemic collaterals, which is essential to understand the rationale for the use of the endovascular procedures analysed.
In a second section, the clinical guidance focuses on the recent advances in invasive procedures and their use in the management of bleeding from oesophageal varices. Although the use of the TIPS (transjugular intrahepatic portosystemic shunt) technique dates back to the 1980s, in recent years there have been several technical refinements in the stents used (devices consisting of a tubular metal mesh that is inserted into a blood vessel to correct narrowing and stop blockages), which are described in the document. The other important addition in the management of oesophageal variceal bleeding is the introduction of the embolization of varices, using a technique called retrograde transvenous obliteration.
The final section deals with the clinical use of endovascular treatments in the management of bleeding from oesophageal varices, both in the digestive system and externally.
“The aim of the document is to provide health professionals with an in-depth understanding of the use of TIPS and other interventional radiology techniques in the handling of bleeding due to portal hypertension”, explains Virginia Hernández-Gea.
Lee EW, Eghtesad B, Garcia-Tsao G, Haskal ZJ, Hernandez-Gea V, Jalaeian H, Kalva SP, Mohanty A, Thabut D, Abraldes JG. AASLD Practice Guidance on the Use of TIPS, Variceal Embolization, and Retrograde Transvenous Obliteration in the Management of Variceal Hemorrhage. Hepatology. 2023 Jun 30. doi: 10.1097/HEP.0000000000000530.