The liver is vital to the processing, metabolizing and detoxifying of nutrients and contaminants in the body. Within the liver, a specialized system of blood vessels–the hepatic portal venous system–normally gathers newly digested food and nutrients from the intestines and other organs, and brings them to the liver. Any permanent damage and scarring to the liver (cirrhosis) causes backup of the portal venous system and leads to the development of abnormal, fragile and enlarged veins (varices) and possibly portal hypertension.
Interventional radiologists use minimally invasive, image-guided therapies to treat liver disease, such as portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) Bleeding due to portal hypertension may occur in areas such as the esophagus, stomach, small bowel, large bowel and rectum. Some areas of bleeding may not be treatable with an endoscope. To decrease blood flow and pressure in these enlarged veins (varices), an interventional radiologist may place a transjugular intrahepatic portosystemic shunt (TIPS) that decreases the varices and returns blood to normal circulation. A small incision is made to access the internal jugular vein. Using live x-rays, a catheter is maneuvered through the body’s large veins and into the liver. A small needle is then passed through the liver into the portal venous system. The interventional radiologist then places a stent–a small metallic tube–in the liver to direct blood from the portal venous system/varices back into the normal circulatory system. Patients are kept in the hospital after the procedure to evaluate the success of therapy, assess patient stability after the complex procedure, and monitor for signs of unexpected injury.
Vessels bleeding within the stomach (gastric varices) may be especially difficult to treat with an endoscope. To stop life-threatening bleeding around the stomach, an interventional radiologist may obliterate or block the bleeding vessel by selectively injecting an agent that causes the vessel to scar, a treatment called balloon-occluded retrograde transvenous obliteration (BRTO).
With BRTO, an interventional radiologist makes a small incision in the groin and, using live x-rays, maneuvers a catheter through a large vein in the body (the inferior vena cava) into the veins in the stomach (gastric varices), typically next to the left kidney and adrenal gland. The catheter is then placed near the area of bleeding vessels, and a substance that causes the vessels to clot and scar (sclerosing agent) is injected at the target location. To prevent the sclerosing agent from going to other parts of the body, a large balloon is inflated within the blood vessel prior to injection. Once sufficient time has passed, the toxic agent is removed and the balloon is deflated.