Portal Hypertension, TIPS, and RTO—Latest AASLD Guidance

🎙️ Wysdom Radio: Portal Hypertension, TIPS, and RTO—Latest AASLD Guidance

This episode breaks down the critical differences between the two main endovascular strategies for managing variceal bleeding in patients with portal hypertension:

• TIPS (Transjugular Intrahepatic Portosystemic Shunt): A procedure that acts as an internal bypass to lower the overall portal pressure.

  • New Guidance: Covered stents are now standard, and smaller 8mm stents are preferred to minimize the risk of Hepatic Encephalopathy (HE).

  • Trade-Off: It reduces the risk of bleeding but increases the risk of HE (brain fog/confusion).

• RTO/ATO (Retrograde/Antegrade Transvenous Obliteration): Procedures that physically block and obliterate the specific bleeding veins (varices).

  • Key Difference: RTO/ATO increases portal pressure but is preferred for patients with pre-existing HE or heart issues, as it often improves liver function and has a lower HE risk.

  • Technological Leap: Newer methods like PARTO and CARTO (Coil/Plug-Assisted RTO) are replacing older techniques, offering a safer, faster, and more targeted approach that eliminates the need for prolonged ICU stays.

The Clinical Crossroads: We detail how specialists choose between TIPS (pressure-lowering) and RTO (obliteration) based on patient factors like underlying HE, cardiac health, and the location of the bleeding varices.

Based on comments from experts, content on Wysdom, and the article cited below.

Lee EW, Eghtesad B, Garcia-Tsao G, et al. AASLD practice guidance on the use of TIPS, variceal embolization, and retrograde transvenous obliteration in the management of variceal hemorrhage. Hepatology. 2024;79(1):224-250. doi:10.1097/HEP.0000000000000530