The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Login
EN
+7 (495) 482-4118
+7 (495) 482-4329
+8 800 250-18-12
  • (toll-free number for subscriptions)
    Mon-Fri from 10 a.m. to 6 p.m.

  • © 1998-2026
+7 (495) 482-43-29
EN
All journals
Journal
Year
Year
Search result: 0

Mikhin S.V.

Volgograd State Medical University

Mozgovoy P.V.

Volgograd State Medical University

Kitaeva A.V.

Volgograd State Medical University

Gorbunov D.E.

Volgograd State Medical University

Mikhin I.V.

Volgograd State Medical University

Trends in endovascular treatment and prevention of portal bleeding

Authors:

Mikhin S.V., Mozgovoy P.V., Kitaeva A.V., Gorbunov D.E., Mikhin I.V.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2024;(3): 38‑44

DOI: 10.17116/hirurgia202403138

Read: 1759 times

Download PDF (RU)
Contact the author
Table of contents

TRENDS IN ENDOVASCULAR TREATMENT AND PREVENTION OF PORTAL BLEEDING
TRENDS IN ENDOVASCULAR TREATMENT AND PREVENTION OF PORTAL BLEEDING

To cite this article:

Mikhin SV, Mozgovoy PV, Kitaeva AV, Gorbunov DE, Mikhin IV. Trends in endovascular treatment and prevention of portal bleeding. Pirogov Russian Journal of Surgery. 2024;(3):38‑44. (In Russ.)
https://doi.org/10.17116/hirurgia202403138

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)
МСФ на ЯМ
Использование инфографики авторами научных работ
Close metadata
Recommended articles:
Successful repeated endo­vascular procedure for TIPS thro­mbosis. Piro­gov Russian Journal of Surgery. 2025;(11):129-133
Issues of endo­scopic diagnosis and treatment for complications of portal hype­rtension. Endo­scopic Surgery. 2025;(1):62-69
Resu­lts of application of modi­fied technique of esophageal vari­ces liga­tion in patients with liver cirrhosis combined with hepa­tocellular carcinoma. Endo­scopic Surgery. 2025;(2):17-25
Evaluation of periodontal status in patients with liver cirrhosis. Stomatology. 2025;(2):6-10
Effe­ctiveness of etiotropic therapy in achieving reco­mpensation of cirrhosis. Russian Journal of Evidence-Based Gastroenterology. 2025;(2):68-77
Abstract:

Bleeding from esophageal and gastric varices is a major factor of mortality in patients with portal hypertension. The gold standard for diagnosis of portal hypertension is hepatic venous pressure gradient determining the treatment algorithms and risk of recurrent bleeding. Combination of endoscopic methods and therapy is limited by varix localization and not always effective. In these cases, endovascular bypass and decoupling techniques are preferred. Early endovascular treatment of portal bleeding is effective for hemostasis and higher transplantation-free survival of patients. Early transjugular intrahepatic portosystemic bypass should be associated with 8-mm covered stents of controlled dilation. Combination of endovascular techniques reduces the complications of each technique and potentiates their positive effect. Endovascular treatment and prevention of portal bleeding should be determined by anatomical features of portal venous system.

Keywords:

portal hypertension
esophageal varices
gastric varices
portal bleeding
liver cirrhosis
endovascular techniques
hepatic venous pressure gradient

Authors:

Mikhin S.V.

Volgograd State Medical University

Mozgovoy P.V.

Volgograd State Medical University

Kitaeva A.V.

Volgograd State Medical University

Gorbunov D.E.

Volgograd State Medical University

Mikhin I.V.

Volgograd State Medical University

Received:

01.08.2023

Accepted:

10.09.2023

Close metadata

References:

  1. Gunarathne LS, Rajapaksha H, Shackel N, Angus PW, Herath CB. Cirrhotic portal hypertension: From pathophysiology to novel therapeutics. World Journal of Gastroenterology. 2020;26(40):6111-6140. https://doi.org/10.3748/wjg.v26.i40.6111
  2. Al-Obaid LN, Bazarbashi AN, Ryou M. Variceal Bleeding: Beyond Banding. Digestive Diseases and Sciences. 2022;67(5):1442-1454. https://doi.org/10.1007/s10620-022-07425-8
  3. Efimov DYu, Fedoruk DA, Nosik AV, Kirkovsky LV, Kozak ON, Avdey EL, Savchenko AV, Korotkov SV, Shcherba AE, Rummo OO. Evolution of approaches to portal hypertension syndrome and principles underlying treatment personalization. Annals of HPB Surgery. 2022;27(2):39-47. (In Russ.). https://doi.org/10.16931/1995-5464.2022-2-39-47
  4. Zhou LL, Wang GC, Zhang MY, Huang GJ, Li W, Wang LY, Wang AH, Zhang CQ. Nomogram for hepatic venous pressure gradient in patients with cirrhosis. Journal of Digestive Diseases. 2021;22(8):488-495.  https://doi.org/10.1111/1751-2980.13033
  5. Shao R, Li Z, Wang J, Qi R, Liu Q, Zhang W, Mao X, Song X, Li L, Liu Y, Zhao X, Liu C, Li X, Zuo C, Wang W, Qi X. Hepatic venous pressure gradient-guided laparoscopic splenectomy and pericardial devascularisation versus endoscopic therapy for secondary prophylaxis for variceal rebleeding in portal hypertension (CHESS1803): study protocol of a multicenter randomised controlled trial in China. BMJ. 2020;10(6):e030960. https://doi.org/10.1136/bmjopen-2019-030960
  6. Liu C, Liu Y, Shao R, Wang S, Wang G, Wang L, Zhang M, Hou J, Zhang C, Qi X. The predictive value of baseline hepatic venous pressure gradient for variceal rebleeding in cirrhotic patients receiving secondary prevention. Annals of Translation Medicine. 2020;8(4):91.  https://doi.org/10.21037/atm.2019.12.143
  7. Guo H, Zhang F, Yin X, Zhang M, Xiao J, Wang Y, Zhang B, Zhang W, Zou X, Zhuge Y. Endoscopic therapy + β-blocker vs. covered transjugular intrahepatic portosystemic shunt for prevention of variceal rebleeding in cirrhotic patients with hepatic venous pressure gradient ≥16 mm Hg. European Journal of Gastroenterology & Hepatology. 2021;33(11):1427-1435. https://doi.org/10.1097/MEG.0000000000001872
  8. Khoronko YuV, Kosovtsev EV, Kozyrevskiy MA, Khoronko EYu, Krivorotov NA, Chesnokov VV. Portosystemic shunting procedures for complicated portal hypertension: modern opportunities of mini-invasive technique. Annals of HPB Surgery. 2021;26(3):34-45. (In Russ.). https://doi.org/10.16931/1995-5464.2021-3-34-45
  9. Edelson J, Basso JE, Rockey DC. Updated strategies in the management of acute variceal haemorrhage. Current Opinion in Gastroenterology. 2021;37(3):167-172.  https://doi.org/10.1097/MOG.0000000000000723
  10. Li S, Zhang C, Lin LL, Wang Q, Zuo HX, Zhan AL, Luo J, Niu YM, Zhong GQ. Early-TIPS Versus Current Standard Therapy for Acute Variceal Bleeding in Cirrhosis Patients: A Systemic Review With Meta-analysis. Frontiers in Pharmacology. 2020;11:603.  https://doi.org/10.3389/fphar.2020.00603
  11. Tellez L, Guerrero A, Albillos A. Update on the Diagnosis and Management of Portal Hypertension in Cirrhosis According to the Baveno VII Consensus Conference Recommendations. Revista Espanola De Enfermedades Digestivas. 2022;114(9):534-542.  https://doi.org/10.17235/reed.2022.8868/2022
  12. de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C. Baveno VII — Renewing Consensus in Portal Hypertension. Journal of Hepatology. 2022;76(4):959-974.  https://doi.org/10.1016/j.jhep.2021.12.022
  13. Lv Y, Bai W, Zhu X, Xue H, Zhao J, Zhuge Y, Sun J, Zhang C, Ding P, Jiang Z, Zhu X, Ren W, Li Y, Zhang K, Zhang W, Li K, Wang Z, Luo B, Li X, Yang Z, Wang Q, Guo W, Xia D, Yang C, Pan Y, Yin Z, Fan D, Han G. CLIF-C AD score predicts survival benefit from pre-emptive TIPS in individuals with Child-Pugh B cirrhosis and acute variceal bleeding. JHEP Reports. 2022;4(12):100621. https://doi.org/10.1016/j.jhepr.2022.100621
  14. Lv Y, Yang Z, Liu L, Li K, He C, Wang Z, Bai W, Guo W, Yu T, Yuan X, Zhang H, Xie H, Yao L, Wang J, Li T, Wang Q, Chen H, Wang E, Xia D, Luo B, Li X, Yuan J, Han N, Zhu Y, Niu J, Cai H, Xia J, Yin Z, Wu K, Fan D, Han G; AVB-TIPS Study Group. Early TIPS with Covered Stents Versus Standard Treatment for Acute Variceal Bleeding in Patients with Advanced Cirrhosis: a Randomized Controlled Trial. The Lancet Gastroenterology and Hepatology. 2019;4(8):587-598.  https://doi.org/10.1016/S2468-1253(19)30090-1
  15. García-Pagán JC, Saffo S, Mandorfer M, Garcia-Tsao G. Where Does TIPS Fit in the Management of Patients with Cirrhosis? JHEP Reports. 2020;2(4):100122. https://doi.org/10.1016/j.jhepr.2020.100122
  16. Trivedi S, Lam K, Ganesh A, et al. Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation. Seminars in Interventional Radiology. 2023;40(1):9-14.  https://doi.org/10.1055/s-0043-1764282
  17. Triantafyllou T, Aggarwal P, Gupta E, Svetanoff WJ, Bhirud DP, Singhal S. Polytetrafluoroethylene-Covered Stent Graft Versus Bare Stent in Transjugular Intrahepatic Portosystemic Shunt: Systematic Review and Meta-Analysis. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2018;28(7):867-879.  https://doi.org/10.1089/lap.2017.0560
  18. Zhou Y, Zhang W, Zhang Z, Luo J, Gu J, Liu Q, Ma J, Yan Z, Chen S, Wang J. PTFE-covered TIPS is an Effective Treatment for Secondary Preventing Variceal Rebleeding in Cirrhotic Patients with High Risks. European Journal of Gastroenterology & Hepatology. 2020;32(9):1235-1243. https://doi.org/10.1097/MEG.0000000000001686
  19. Ahmed Z, Hassan M, Arif SF, Aziz M, Iqbal U, Nawaz A, Farooq U, Smith WL, Badal J, Renno A, Javaid T, Nawras A, Saab S. Comparative Efficacy of Treatment Options for the Prevention of Post-TIPS Hepatic Encephalopathy: A Systematic Review and Network Meta-analysis. Journal of Gastrointestinal and Liver Diseases. 2023;32(1):70-76.  https://doi.org/10.15403/jgld-4508
  20. Miraglia R, Maruzzelli L, Di Piazza A, Mamone G, Caruso S, Gentile G, Tuzzolino F, Floridia G, Petridis I, Volpes R, Luca A. Transjugular Intrahepatic Portosystemic Shunt Using the New Gore Viatorr Controlled Expansion Endoprosthesis: Prospective, Single-Center, Preliminary Experience. CardioVascular and Interventional Radiology. 2019;42(1):78-86.  https://doi.org/10.1007/s00270-018-2040-y
  21. Gupta AN, Sze DY, Rigas DA. Smaller Diameter and Adjustable Diameter Transjugular Intrahepatic Portosystemic Shunts. Seminars in Interventional Radiology. 2023;40(1):21-26.  https://doi.org/10.1055/s-0043-1764285
  22. Trieu H, Lee EW. A New and Improved Transjugular Intrahepatic Portosystemic Shunt (TIPS) stent graft: Controlled expansion. Gastrointestinal Intervention. 2018;7:18-20.  https://doi.org/10.18528/gii180007
  23. Luo X, Wang X, Zhu Y, Xi X, Zhao Y, Yang J, Li X, Yang L. Clinical Efficacy of Transjugular Intrahepatic Portosystemic Shunt Created with Expanded Polytetrafluoroethylene-Covered Stent-Grafts: 8-mm Versus 10-mm. CardioVascular and Interventional Radiology. 2019;42(5):737-743.  https://doi.org/10.1007/s00270-019-02162-4
  24. Khakwani A, Trivedi M, Afzal M, Kahlon P, Khola, Patel P, Chirumamilla PC, Vohra RR, Ratheesh R, Mathew M, Abdin ZU, Nazir Z. Use of Balloon Occluded Retrograde Transvenous Obliteration (BRTO) for Treatment of Gastric Varices: A Narrative Review. Cureus. 2023;15(4):e38233. https://doi.org/10.7759/cureus.38233
  25. Paleti S, Nutalapati V, Fathallah J, Jeepalyam S, Rustagi T. Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Versus Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Treatment of Gastric Varices Because of Portal Hypertension: A Systematic Review and Meta-Analysis. Journal of Clinical Gastroenterology. 2020;54(7):655-660.  https://doi.org/10.1097/MCG.0000000000001275
  26. Lipnik AJ, Pandhi MB, Khabbaz RC, Gaba RC. Endovascular Treatment for Variceal Hemorrhage: TIPS, BRTO, and Combined Approaches. Seminars in Interventional Radiology. 2018;35(3):169-184.  https://doi.org/10.1055/s-0038-1660795
  27. Stein DJ, Salinas C, Sabri S, Onyeali R, Caldwell S, Henry Z. Balloon Retrograde Transvenous Obliteration Versus Endoscopic Cyanoacrylate in Bleeding Gastric Varices: Comparison of Rebleeding and Mortality with Extended Follow-up. Journal of Vascular and Interventional Radiology. 2019;30(2):187-194.  https://doi.org/10.1016/j.jvir.2018.12.008
  28. Philips CA, Ahamed R, Rajesh S, George T, Mohanan M, Augustine P. Beyond the Scope and the Glue: Update on Evaluation and Management of Gastric Varices. BMC Gastroenterology. 2020;20(1):361.  https://doi.org/10.1186/s12876-020-01513-7
  29. Gimm G, Chang Y, Kim HC, Shin A, Cho EJ, Lee JH, Yu SJ, Yoon JH, Kim YJ. Balloon-Occluded Retrograde Transvenous Obliteration versus Transjugular Intrahepatic Portosystemic Shunt for the Management of Gastric Variceal Bleeding. Gut Liver. 2018;12(6):704-713.  https://doi.org/10.5009/gnl17515
  30. Maydeo A, Patil G. How to Approach a Patient With Gastric Varices. Gastroenterology. 2022;162(3):689-695.  https://doi.org/10.1053/j.gastro.2021.12.277
  31. Jachs M, Reiberger T. Prevention of Variceal Bleeding and Rebleeding by Nonselective Beta-Blockers: A Tailored Approach. Clinics in Liver Disease. 2021;25(2):311-326.  https://doi.org/10.1016/j.cld.2021.01.004
  32. Cheikhna FZ, Elgasmi N, Tahiri M, Elrhaoussi FZ, Haddad F, Hliwa W, Bellabah A, Badre W. Gastrointestinal Bleeding due to the Expulsion of Cyanoacrylate Glue After Endoscopic Embolization of Gastric Varices: a Case Report. The Pan African Medical Journal. 2022;43:75.  https://doi.org/10.11604/pamj.2022.43.75.30034
  33. Sen G, Papasozomenos G, Papachristidis A, Patel VC, Sado D. Images of the month 1: Histoacryl glue embolisation to the right ventricle following treatment for gastric varices. Clinical Medicine. 2022;22(2):163-164.  https://doi.org/10.7861/clinmed.2021-0739
  34. Prasoppokakorn T, Rerknimitr R. An Unusual Complication of Endoscopic Cyanoacrylate Injection for Gastric Varix. Gastroenterology. 2022;163(5):1186-1187. https://doi.org/10.1053/j.gastro.2022.06.002
  35. Vaz K, Efthymiou M, Vaughan R, Testro AG, Lew HB, Pu LZCT, Chandran S. Unpacking the challenge of gastric varices: A review on indication, timing and modality of therapy. World Journal of Hepatology. 2021;13(8):868-878.  https://doi.org/10.4254/wjh.v13.i8.868
  36. Kotiv BN, Dzidzava II, Onnicev IE, Khokhlov AV, Zubarev PN, Soldatov AS, Shevtsov SV, Parfenov AO. Surgical treatment of bleeding from esophageal and gastric varices in patients with decompensated cirrhosis. Kursk Scientific and Practical Bulletin «Man and His Health». 2018;2:27-33. (In Russ.). https://doi.org/10.21626/vestnik/2018-2/04
  37. Goral V, Yılmaz N. Current Approaches to the Treatment of Gastric Varices: Glue, Coil Application, TIPS, and BRTO. Medicina. 2019;55(7):335.  https://doi.org/10.3390/medicina55070335
  38. Mou H, Liu Q, Fan Y, Shi G, Wu H, Tuo B, Xie R. Nylon Ring With Titanium Clip Assists Endoscopic Cyanoacrylate Injection for the Treatment of GOV1-type Gastric Varices. Endoscopy. 2023;55(S 01):E578-E580. https://doi.org/10.1055/a-2011-5595
  39. Sabry F, Seif S, Eldesoky A, Hakim H, Altonbary AY. EUS-guided Cyanoacrylate Injection Into the Perforating Vein Versus Direct Endoscopic Injection in the Treatment of Gastric Varices. Endoscopy International Open. 2023;11(2):E202-E210. https://doi.org/10.1055/a-1984-7070
  40. Calmet F, Mohan P, Jalaeian H, Martin P. Management of Patients With Gastric Varices. Gastroenterology and Hepatology. 2022;18(10):574-585. 
  41. Giri S, Jearth V, Seth V, Darak H, Sundaram S. Comparison of Efficacy and Safety of Endoscopic and Radiological Interventions for Gastric Varices: A Systematic Review and Network Meta-analysis. Clinical and Experimental Hepatology. 2023;9(1):57-70.  https://doi.org/10.5114/ceh.2023.126077
  42. Jamwal KD, Padhan RK, Sharma A, Sharma MK. Endoscopic Ultrasound-guided Coiling and Glue is Safe and Superior to Endoscopic Glue Injection in Gastric Varices With Severe Liver Disease: a Retrospective Case Control Study. Clinical Endoscopy. 2023;56(1):65-74.  https://doi.org/10.5946/ce.2021.119
  43. Kim DJ, Darcy MD, Mani NB, Park AW, Akinwande O, Ramaswamy RS, Kim SK. Modified Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Techniques for the Treatment of Gastric Varices: Vascular Plug-Assisted Retrograde Transvenous Obliteration (PARTO)/Coil-Assisted Retrograde Transvenous Obliteration (CARTO)/Balloon-Occluded Antegrade Transvenous Obliteration (BATO). CardioVascular and Interventional Radiology. 2018;41(6):835-847.  https://doi.org/10.1007/s00270-018-1896-1
  44. Yokoyama K, Yamauchi R, Shibata K, Fukuda H, Kunimoto H, Takata K, Tanaka T, Inomata S, Morihara D, Takeyama Y, Shakado S, Sakisaka S. Endoscopic treatment or balloon‐occluded retrograde transvenous obliteration is safe for patients with esophageal/gastric varices in Child‐Pugh class C end‐stage liver cirrhosis. Clinical and Molecular Hepatology. 2019;25:183-189.  https://doi.org/10.3350/cmh.2018.0039
  45. Tamura Y, Asaoka Y, Takeuchi A, Matsumoto K, Miura R, Abe K, Arizumi T, Yamamoto M, Kodashima S, Kondo H, Yamamoto T, Tanaka A. Long-Term Prognosis and Related Factors in Patients with Cirrhosis Treated with Balloon-Occluded Retrograde Transvenous Obliteration. Digestive Diseases. 2023;1-9.  https://doi.org/10.1159/000530781
  46. Khakwani A, Trivedi M, Afzal M, Kahlon P, Khola, Patel P, Chirumamilla PC, Vohra RR, Ratheesh R, Mathew M, Abdin ZU, Nazir Z. Use of Balloon Occluded Retrograde Transvenous Obliteration (BRTO) for Treatment of Gastric Varices: A Narrative Review. Cureus. 2023;15(4):e38233. https://doi.org/10.7759/cureus.38233
  47. Osman KT, Nayfeh T, Abdelfattah AM, Alabdallah K, Hasan B, Firwana M, Alabaji H, Elkhabiry L, Mousa J, Prokop LJ, Murad MH, Gordon F. Secondary Prophylaxis of Gastric Variceal Bleeding: A Systematic Review and Network Meta-Analysis. Liver Transplantation. 2022;28(6):945-958.  https://doi.org/10.1002/lt.26383
  48. Manukyan GV, Malov SL, Musin RA, Zhigalova SB, Lebezev VM, Kitsenko EA, Fandeyev EE. First Experience of Balloon-occluded Retrograde Transvenous Obliterationof Gastric Varices. Annals of HPB Surgery. 2022;27(2):58-65. (In Russ.). https://doi.org/10.16931/1995-5464.2022-2-58-64
  49. Yu Q, Liu C, Raissi D. Balloon-occluded Retrograde Transvenous Obliteration Versus Transjugular Intrahepatic Portosystemic Shunt for Gastric Varices: A Meta-Analysis. Journal of Clinical Gastroenterology. 2021;55(2):147-158.  https://doi.org/10.1097/MCG.0000000000001305
  50. Liu J, Yang C, Huang S, Zhou C, Shi Q, Qian K, Song S, Xiong B. The Combination of Balloon-assisted Antegrade Transvenous Obliteration and Transjugular Intrahepatic Portosystemic Shunt for the Management of Cardiofundal Varices Hemorrhage. European Journal of Gastroenterology & Hepatology. 2020;32:656-662.  https://doi.org/10.1097/MEG.0000000000001705
  51. Shirane Y, Murakami E, Imamura M, Kosaka M, Johira Y, Miura R, Murakami S, Yano S, Amioka K, Naruto K, Ando Y, Uchikawa S, Teraoka Y, Uchida T, Fujino H, Ono A, Nakahara T, Kawaoka T, Miki D, Yamauchi M, Okamoto W, Tsuge M, Chosa K, Awai K, Aikata H, Oka S. Hepatic Venous Pressure Gradient After Balloon-occluded Retrograde Transvenous Obliteration and Liver Stiffness Measurement Predict the Prognosis of Patients With Gastric Varices. BMC Gastroenterology. 2022;22(1):535.  https://doi.org/10.1186/s12876-022-02616-z
  52. Mukund A, Rangarh P, Shasthry SM, Patidar Y, Sarin SK. Salvage Balloon Occluded Retrograde Transvenous Obliteration for Gastric Variceal Bleed in Cirrhotic Patients with Endoscopic Failure to Control Bleed/Very Early Rebleed: Long-term Outcomes. Journal of Clinical and Experimental Hepatology. 2020;10(5):421-428.  https://doi.org/10.1016/j.jceh.2020.04.010
Contact the author
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

Contact us
If you have any questions, complaints or suggestions, please use this feedback form.
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.
Submit Application

You can become an author of one of our magazines, send a request and we will consider it in during the day.

Name
Phone
E-mail
Message
Login
Registration
E-mail
Password
Forgot Password?

Log in to the site using your account in one of the services

Password recovery
E-mail
Login
Register

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.