Macrophage function in cirrhosis and the risk of bacterial infection

✍ Scribed by Associate Professor Carlos Guarner; Bruch A. Runyon

• Book ID: 102238889
• Publisher: John Wiley and Sons
• Year: 1995
• Tongue: English
• Weight: 430 KB
• Volume: 22
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.1840220149

✦ Synopsis

TIPS have come to the conclusion that stents 10 mm in diameter are probably ideal. In both PCA and TIPS, shunts of such size appear to maintain hepatopedal blood flow, to eliminate hemorrhage from varices, and to ameliorate ascites. Larger shunts of both types also do so, but frequently precipitate PSE. Pseudointimal hyperplasia, which is a delayed complication of TIPS but not of PCA, often induces stent stenosis and sometimes complete occlusion. As it reduces blood flow through the stent, it tends to minimize the incidence and severity of PSE. This interplay characterizes the relative roles of the size of the stent, the efficacy of portal decompression, and the prevalence of PSE. Obviously, randomized clinical trials that compare the effects of such shunts of different size on portal venous pressure and blood flow and flow through the shunts are needed. Indeed, protocols for such investigations are currently being assessed.

Portacaval anastomoses, whether surgical, angiographic or spontaneous will be with us for the forseeable future.