Endovascular Treatment of Portal Hypertension

Endovascular therapies have largely replaced surgical treatment in the management of portal hypertension in current practice. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective tool for portal decompression and can be used to treat sequela of portal hypertension, including variceal bleeding, bleeding related to portal hypertensive gastropathy, refractory acites and hepatic hydrothorax. Other endovascular techniques such as balloon-occluded retrograde transvenous obliteration (BRTO), have demonstrated promising results in treating bleeding gastric varices, which are notoriously difficult to treat via endoscopy and may respond less effectively to TIPS. Endovascular therapies such as catheter-directed thrombolysis, venous stenting, and TIPS have proven useful in the treatment of Budd-Chiari syndrome (BCS). Portosystemic shunting can induce hepatic encephalopathy and should be used as a second-line therapy after failure of medical management. The decision to use these endovascular therapies should be made in conjunction with hepatologists or gastroenterologists experienced in the management of portal hypertension.