THE ROLE OF INTERVENTIONAL RADIOLOGY IN THE COMPLEX MANAGEMENT OF PORTAL HYPERTENSION COMPLICATIONS. LITERATURE REVIEW
Introduction. Portal hypertension in cirrhosis remains a cause of complications (variceal bleeding, ascites, hypersplenism, hepatic encephalopathy); minimally invasive interventional tactics are indicated in a significant proportion of patients.
Purpose of the study. To summarize data on the efficacy and safety of TIPS, BRTO/PARTO/CARTO, PTHVE and partial splenic artery embolization (PSE), as well as on portal pressure monitoring and postoperative management.
Search strategy. Review (2005–2025) in PubMed/MEDLINE, Scopus, Web of Science, eLIBRARY; RCTs, cohort/retrospective studies, meta-analyses were included; observational studies, abstracts and outdated reviews were excluded. A total of 315 studies were identified, 58 of which were included in the analysis.
Results. Endoscopic ligation provides primary hemostasis in 90–95% and, when combined with β-blockers, reduces recurrence by 40–50%; PTHVE – hemostasis 85–95%, 1-year recurrence ~15–20%, serious complications 3–5%; TIPS prevents recurrence in 80–90% of patients, PE 25–35%; the addition of embolization to TIPS reduces the risk of rebleeding (RR≈0.58), with post-TIPS PPG >12 mmHg – HR≈0.47; for gastric varices BRTO – success 90–95%, PE <5%, PARTO/CARTO are comparable; in refractory ascites TIPS reduces the recurrence rate by more than 70%; PSE increases platelet count by 40–60%: effect lasts ≥6–12 months. Optimization and monitoring: 8 mm stents reduce PE rate; success – HVPG reduction by ≥20–30% or <12 mmHg; Doppler signs of dysfunction – velocity <90 cm/s or >50% gradient; CT/MRI control at 4–6 weeks, ultrasound every 3 months.
Conclusions. Interventional radiology is central; novelty – PPG-guided stratification (>12 mmHg), monitoring, solutions for PE reduction (8 mm stents); questions of transhepatic pressure measurement standardization and optimal intervention sequence remain, requiring prospective studies.
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Axultanov N.A., Dautov T.B., Zemlyanskiy V.V., Ten I.E., Rakhimzhanova R.I., Dogalbayev Ye.K., Tukinov R.Ya., Tulemissov A.K., Abdrakhmanova Zh.S., Temirbekov A.Zh. The role of interventional radiology in the complex management of portal hypertension complications. Literature review // Nauka i Zdravookhranenie [Science & Healthcare]. 2025. Vol.27 (6), pp. 159-171. doi 10.34689/SH.2025.27.6.018Похожие публикации:
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