Image-Guided Intervention in Managing Portal Hypertension

Alternatives are presented to transjugular intrahepatic portosystemic shunt placement.

Course ID: Q00405 Category:
Modality:

3.5

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$37.00

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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.50
Procedures: 1.50
Abdomen and Pelvis: 1.50

Registered Radiologist Assistant: 3.50
Procedures: 3.50
Neurological, Vascular, and Lymphatic Sections: 3.50

Vascular-Interventional Radiography: 2.25
Procedures: 2.25
Vascular Interventional Procedures: 2.25

Outline

  1. Introduction
  2. Portal Hypertension
  3. Portosystemic Collateral Vessels
  4. Interventions in Portal Hypertension
  5. Selection of Procedure and Access
  6. TIPS: Indications, Limitations, and Challenges
  7. Recanalization of the Hepatic Vein
  8. Recanalization of the Portal Vein and Its Tributaries
  9. Embolization of APF
  10. Partial Splenic Embolization
  11. Percutaneous Transhepatic Variceal Embolization
  12. BRTO of Varices
  13. Ectopic Varices: Percutaneous Access and Sclerotherapy
  14. Surgical Shunts
  15. Peritoneovenous Shunt
  16. Conclusion

Objectives

Upon completion of this course, students will:

  1. define portal hypertension
  2. define portal pressure gradient
  3. list the classifications of portal hypertension
  4. understand the cause of intra-hepatic portal hypertension
  5. list the sites for ectopic varices
  6. know the number of common portosystemic venous collateral pathways
  7. list the consequences of portal hypertension
  8. define ascites
  9. discuss the primary goal in treating portal hypertension
  10. list the medications to treat portal hypertension
  11. identify the grades of esophageal varices
  12. classify the fluid types related to portal hypertension
  13. list considerations for treatment of patients with portal hypertension
  14. summarize the common access routes for portal venous system intervention
  15. understand the risks associated with transhepatic access to the portal venous system
  16. describe TIPS placement location
  17. list the indications for TIPS placement
  18. associate MELD score with mortality rates for TIPS patients
  19. differentiate between absolute and relative contraindications for TIPS placement
  20. understand TIPS access routes in patients with challenging vascular anatomy
  21. know the causes of Budd-Chiari syndrome
  22. define DIPS
  23. list the methods used to recanalize the hepatic vein or IVC
  24. know the success rate in the Li et al study regarding recanalization of the hepatic vein
  25. list the symptoms of extrahepatic obstruction of the portal vein
  26. distinguish the segments of the liver
  27. differentiate the caudate lobe of the liver from other liver segments
  28. list the symptoms of arterio-portal fistulas
  29. classify arterio-portal fistulas
  30. understand the purpose of partial splenic embolization
  31. know how splenic embolization can affect risk
  32. summarize the effective use of PTE
  33. understand the use and choice of coils for PTE
  34. describe how fundal and fundal-cardiac varices drain
  35. list the risks to balloon rupture during BRTO
  36. differentiate between all classes of gastric varices
  37. explain the studies related to gastric variceal classification
  38. know the advantages of BRTO over TIPS placement
  39. recognize the percentage of portal hypertension patients that develop stomal varices
  40. recognize the main presentation of stomal varices
  41. list the types of portosystemic shunt placement procedures
  42. describe the placement of a portocaval shunt
  43. recall the possible dysfunctions associated with portosystemic shunts
  44. define serial paracentesis
  45. list the complications associated with peritoneovenous shunt placement