Liver/Biliary/Enteric

Transjugular intrahepatic portosystemic shunt (TIPS)

Gastric variceal (GV) bleeding is a complication of portal hypertension (a condition usually due to liver cirrhosis), affecting 20% of these patients and putting them at a higher risk of mortality. GVs are difficult to treat due to their size, location and high volume of blood flow.

The TIPS procedure creates an artificial channel within the liver between the portal vein and the hepatic vein. During the procedure, an interventional radiologist uses image guidance to place the shunt (a special mesh tube) with a catheter via the jugular vein in the neck. This creates the alternative pathway for venous circulation, resulting in less fluid congestion and better circulation.

Balloon-occluded Retrograde Transvenous Obliteration

Balloon-occluded retrograde transvenous obliteration (BRTO) is a safe an effective procedure to treat GV and reduce the risk of re-bleeding. It is an alternative or an adjunct to the TIPS procedure, which is not always effective in patients with low initial portal pressure, or in patients with encephalopathy or poor liver function.

During the procedure, an interventional radiologists uses imaging guidance to identify the inferior phrenic vein and guide a special balloon catheter into it. The balloon is inflated to block the outflow of the varices, and then a sclerosing agent is directly injected into the dilated vein.

Denver Shunt

The Denver Shunt—or peritoneovenous shunt—is an alternate to the TIPS procedure for patients with cirrhosis and refractory ascites who are not candidates for liver transplantation or TIPS. During the procedure, an interventional radiologist inserts a catheter through the jugular vein in the neck and threads it to the liver and the hepatic vein, where he or she creates a shunt that connects the peritoneal cavity to the neck, creating an alternative pathway for venous circulation. A pressure-sensitive one-way valve is then placed to prevent backflow. The Denver shunt is an effective alternative to repeat paracentesis.

Gastrostomy Tube (G-Tube) Placement

A gastrostomy tube, or G-tube, is a feeding tube that is placed through the skin of the abdomen and into the stomach. It is used on either a temporary or permanent basis for patients who are unable to chew and eat food on their own.

G-Tube placement may be performed by an interventional radiologist less invasively than the surgical alternative, and without requiring general anesthesia. During this procedure, imaging guidance is used to place the tube through a small incision in the abdomen. Once the tube is in place it is secured to the abdominal wall and stomach, and no stitches are required.

This method does not usually require the patient to spend the evening in the hospital. After the procedure, the tube may be used in about 24 hours. Compared with surgical alternatives, G-Tube placement by an interventional radiologist is less invasive, and results in fewer complications and a faster recovery.