The liver is an organ about the size of a football that sits just under the rib cage on the right side of the abdomen. It is essential for digesting food and ridding your body of toxic substances.
Liver disease can be caused by a variety of factors such as viruses and alcohol use. Obesity is also associated with liver damage. Over time, damage to the liver results in scarring (cirrhosis), which can lead to liver falure, a life threatening condition.
Many complications can occur with liver scarring, or cirrhosis. This is mainly due to an elevation of the blood pressure within a system of veins called the portal venous system. Veins coming from the stomach, intestine, spleen, and pancreas, merge into the portal vein, which then travels through the liver.
If the liver is diseased or scarred, blood cannot flow properly through the liver and high pressure in the portal venous system develops. This can lead to the development of large swollen veins (called “varices”) within the esophagus, stomach, rectum, or belly button. These can rupture and bleed, resulting in potentially life-threatening complications. Commonly, the elevation in the portal venous pressure can also lead to an accumulation of fluid in the abdomen, also known as “ascites.” Other complications of portal venous hypertension include increased confusion and forgetfulness, also known as “encephalopathy,” and a reduction in the levels of platelets, which are blood cells that help form blood clots.
Portal Hypertension Clinic
VIR has pioneered the nation’s first “Portal Hypertension” Clinic, headed by Dr. George Behrens. This clinic is designed for patients who have liver disease and complications of portal hypertension such as ascites, bleeding, and encephalopathy. In addition, through our relationships with transplant centers in Chicago, we help facilitate some of the workup that is needed while a patient undergoes an evaluation for a possible liver transplant.
At our appointments, patients with liver disease are tested for portal hypertension, screened for complications of portal hypertension, and managed both with medications as well as with treatments discussed below.
The TIPS Procedure
If medical therapy fails to be an effective liver failure treatment, a procedure called Transjugular Intrahepatic Portal-systemic Shunt (TIPS) can be performed. The traditional open surgical bypass has a 10-60 percent mortality (death risk). Procedure-related mortality due to TIPS procedures is rare.
This non-surgical treatment involves creating a bypass inside the liver using balloon angioplasty and stent-graft technology. X-ray guidance is used to find the correct vessels and to form a short pathway between them inside the liver. This relieves the high pressure in the veins and reverses the tendency for bleeding and fluid accumulation.
Here, a catheter carrying an expandable stent has been placed through the liver, non-surgically.
The stent is allowed to expand, creating a flow from high to low pressure veins, relieving portal hypertension.
The TIPS procedure may be a bridge to liver transplantation in very sick patients. Some patients may be too ill to have the procedure however. Careful evaluation and consultation with other specialists regarding treatments for liver failure is performed in every case.
BRTO (Balloon-Occluded Retrograde Tranvenous Obliteration of Gastric varices)
This newer procedure treats a very difficult problem, related to liver cirrhosis and portal hypertension. When cirrhosis creates high pressure in abdominal veins, large varicose veins (gastric varices) may bulge into the stomach and cause deadly bleeding. In this procedure, the varicose veins are reached with an image guided catheter and a sclerosing liquid is pumped into them, stopping all blood flow. They then become obliterated over time, permanently reducing risk of bleeding.
Denver Shunt placement for abdominal Fluid accumulation
Some patients with liver failure may not be candidate for TIPS creation. When fluid builds up in the abdomen, and medical treatment fails to keep up, a Denver Shunt can be placed to allow the body to re-absorb the fluid and decrease water weight gain. The device returns the fluid directly to the patient’s veins, allowing them to keep precious proteins and other necessary things lost when fluid is drained out of the body and discarded. We place these shunts non-surgically, using image guidance, in appropriate patients.
If you or a loved one might be a candidate for a TIPS, or other treatments, ask your doctor. To schedule a clinic consultation,contact us for information regarding treatments for liver failure or call (630) 856-7460.