AC Search
Document Navigator

Radiologic Management of Portal Hypertension

Variant: 1   Acute variceal bleeding. Child-Pugh class A, cirrhotic with index bleed from acute esophageal variceal hemorrhage, MELD 10, no encephalopathy. Initial therapy.
Procedure Appropriateness Category
Endoscopic management Usually Appropriate
Medical therapy with vasoactive drugs Usually Appropriate
Transjugular intrahepatic portosystemic shunt Usually Not Appropriate
Surgical shunt Usually Not Appropriate
Coated esophageal self-expandable metal stent Usually Not Appropriate

Variant: 2   Acute variceal bleeding. Child-Pugh class B, cirrhotic with active esophageal variceal hemorrhage, MELD 12, previously treated with octreotide and variceal ligation (EVL) on three prior occasions, no encephalopathy.
Procedure Appropriateness Category
Endoscopic management Usually Appropriate
Medical therapy with vasoactive drugs Usually Appropriate
Transjugular intrahepatic portosystemic shunt Usually Appropriate
Surgical shunt May Be Appropriate
Coated esophageal self-expandable metal stent Usually Not Appropriate

Variant: 3   Acute variceal bleeding. Child-Pugh class C, cirrhotic with active esophageal and junctional variceal hemorrhage, previously treated with octreotide and endoscopic sclerotherapy, MELD 17, intermittent mild hepatic encephalopathy managed as an outpatient with nutritional support.
Procedure Appropriateness Category
Endoscopic management Usually Appropriate
Medical therapy with vasoactive drugs Usually Appropriate
Transjugular intrahepatic portosystemic shunt Usually Appropriate
Coated esophageal self-expandable metal stent May Be Appropriate
Surgical shunt May Be Appropriate

Variant: 4   Acute variceal bleeding. Child-Pugh class C, cirrhotic with hepatocellular carcinoma, branch portal vein tumor thrombus, and active esophageal and gastroesophageal type 1 (GOV1) variceal hemorrhage, MELD 24.
Procedure Appropriateness Category
Endoscopic management Usually Appropriate
Medical therapy with vasoactive drugs Usually Appropriate
Percutaneous transhepatic embolization Usually Appropriate
Coated esophageal self-expandable metal stent May Be Appropriate
Transjugular intrahepatic portosystemic shunt May Be Appropriate
Surgical shunt Usually Not Appropriate

Variant: 5   Ascites. Initial therapy for Child-Pugh class B cirrhotic asymptomatic patient with small-volume ascites.
Procedure Appropriateness Category
Medical therapy and dietary modification Usually Appropriate
Large-volume paracentesis Usually Not Appropriate
Volume expansion Usually Not Appropriate
Peritoneovenous shunt Usually Not Appropriate
Transjugular intrahepatic portosystemic shunt Usually Not Appropriate

Variant: 6   Ascites. Child-Pugh class B cirrhotic with chronic ascites despite daily diuretic therapy and low-sodium diet.
Procedure Appropriateness Category
Medical therapy and dietary modification Usually Appropriate
Large-volume paracentesis Usually Appropriate
Transjugular intrahepatic portosystemic shunt Usually Appropriate
Volume expansion Usually Appropriate
Peritoneovenous shunt Usually Not Appropriate

Variant: 7   Ascites. Child-Pugh class B cirrhotic with chronic ascites undergoing weekly large-volume paracentesis; rapidly declining renal function unresponsive to diuretic withdrawal.
Procedure Appropriateness Category
Transjugular intrahepatic portosystemic shunt Usually Appropriate
Medical therapy and dietary modification Usually Appropriate
Volume expansion Usually Appropriate
Large-volume paracentesis May Be Appropriate
Peritoneovenous shunt Usually Not Appropriate

Panel Members
Jason W. Pinchot, MDa; Sanjeeva P. Kalva, b; Charles Y. Kim, MDc; Bill S. Majdalany, MDd; Osmanuddin Ahmed, MDe; Sumeet K. Asrani, MD, MScf; Brooks D. Cash, MDg; Jens Eldrup-Jorgensen, MDh; A. Tuba Karagulle Kendi, MDi; Matthew J. Scheidt, MDj; David M. Sella, MDk; Karin E. Dill, MDl; Eric J. Hohenwalter, MDm.
Summary of Literature Review
Introduction/Background
Diagnosis of Cirrhosis and Portal Hypertension
Discussion of Procedures by Variant
Variant 1: Acute variceal bleeding. Child-Pugh class A, cirrhotic with index bleed from acute esophageal variceal hemorrhage, MELD 10, no encephalopathy. Initial therapy.
Variant 1: Acute variceal bleeding. Child-Pugh class A, cirrhotic with index bleed from acute esophageal variceal hemorrhage, MELD 10, no encephalopathy. Initial therapy.
A. Coated esophageal self-expandable metal stent
Variant 1: Acute variceal bleeding. Child-Pugh class A, cirrhotic with index bleed from acute esophageal variceal hemorrhage, MELD 10, no encephalopathy. Initial therapy.
B. Endoscopic management
Variant 1: Acute variceal bleeding. Child-Pugh class A, cirrhotic with index bleed from acute esophageal variceal hemorrhage, MELD 10, no encephalopathy. Initial therapy.
C. Medical therapy with vasoactive drugs
Variant 1: Acute variceal bleeding. Child-Pugh class A, cirrhotic with index bleed from acute esophageal variceal hemorrhage, MELD 10, no encephalopathy. Initial therapy.
D. Surgical shunt
Variant 1: Acute variceal bleeding. Child-Pugh class A, cirrhotic with index bleed from acute esophageal variceal hemorrhage, MELD 10, no encephalopathy. Initial therapy.
E. Transjugular intrahepatic portosystemic shunt
Variant 2: Acute variceal bleeding. Child-Pugh class B, cirrhotic with active esophageal variceal hemorrhage, MELD 12, previously treated with octreotide and variceal ligation (EVL) on three prior occasions, no encephalopathy.
Variant 2: Acute variceal bleeding. Child-Pugh class B, cirrhotic with active esophageal variceal hemorrhage, MELD 12, previously treated with octreotide and variceal ligation (EVL) on three prior occasions, no encephalopathy.
A. Coated esophageal self-expandable metal stent
Variant 2: Acute variceal bleeding. Child-Pugh class B, cirrhotic with active esophageal variceal hemorrhage, MELD 12, previously treated with octreotide and variceal ligation (EVL) on three prior occasions, no encephalopathy.
B. Endoscopic management
Variant 2: Acute variceal bleeding. Child-Pugh class B, cirrhotic with active esophageal variceal hemorrhage, MELD 12, previously treated with octreotide and variceal ligation (EVL) on three prior occasions, no encephalopathy.
C. Medical therapy with vasoactive drugs
Variant 2: Acute variceal bleeding. Child-Pugh class B, cirrhotic with active esophageal variceal hemorrhage, MELD 12, previously treated with octreotide and variceal ligation (EVL) on three prior occasions, no encephalopathy.
D. Surgical shunt
Variant 2: Acute variceal bleeding. Child-Pugh class B, cirrhotic with active esophageal variceal hemorrhage, MELD 12, previously treated with octreotide and variceal ligation (EVL) on three prior occasions, no encephalopathy.
E. Transjugular intrahepatic portosystemic shunt
Variant 3: Acute variceal bleeding. Child-Pugh class C, cirrhotic with active esophageal and junctional variceal hemorrhage, previously treated with octreotide and endoscopic sclerotherapy, MELD 17, intermittent mild hepatic encephalopathy managed as an outpatient with nutritional support.
Variant 3: Acute variceal bleeding. Child-Pugh class C, cirrhotic with active esophageal and junctional variceal hemorrhage, previously treated with octreotide and endoscopic sclerotherapy, MELD 17, intermittent mild hepatic encephalopathy managed as an outpatient with nutritional support.
A. Coated esophageal self-expandable metal stent
Variant 3: Acute variceal bleeding. Child-Pugh class C, cirrhotic with active esophageal and junctional variceal hemorrhage, previously treated with octreotide and endoscopic sclerotherapy, MELD 17, intermittent mild hepatic encephalopathy managed as an outpatient with nutritional support.
B. Endoscopic management
Variant 3: Acute variceal bleeding. Child-Pugh class C, cirrhotic with active esophageal and junctional variceal hemorrhage, previously treated with octreotide and endoscopic sclerotherapy, MELD 17, intermittent mild hepatic encephalopathy managed as an outpatient with nutritional support.
C. Medical therapy with vasoactive drugs
Variant 3: Acute variceal bleeding. Child-Pugh class C, cirrhotic with active esophageal and junctional variceal hemorrhage, previously treated with octreotide and endoscopic sclerotherapy, MELD 17, intermittent mild hepatic encephalopathy managed as an outpatient with nutritional support.
D. Surgical shunt
Variant 3: Acute variceal bleeding. Child-Pugh class C, cirrhotic with active esophageal and junctional variceal hemorrhage, previously treated with octreotide and endoscopic sclerotherapy, MELD 17, intermittent mild hepatic encephalopathy managed as an outpatient with nutritional support.
E. Transjugular intrahepatic portosystemic shunt
Variant 4: Acute variceal bleeding. Child-Pugh class C, cirrhotic with hepatocellular carcinoma, branch portal vein tumor thrombus, and active esophageal and gastroesophageal type 1 (GOV1) variceal hemorrhage, MELD 24.
Variant 4: Acute variceal bleeding. Child-Pugh class C, cirrhotic with hepatocellular carcinoma, branch portal vein tumor thrombus, and active esophageal and gastroesophageal type 1 (GOV1) variceal hemorrhage, MELD 24.
A. Coated esophageal self-expandable metal stent
Variant 4: Acute variceal bleeding. Child-Pugh class C, cirrhotic with hepatocellular carcinoma, branch portal vein tumor thrombus, and active esophageal and gastroesophageal type 1 (GOV1) variceal hemorrhage, MELD 24.
B. Endoscopic management
Variant 4: Acute variceal bleeding. Child-Pugh class C, cirrhotic with hepatocellular carcinoma, branch portal vein tumor thrombus, and active esophageal and gastroesophageal type 1 (GOV1) variceal hemorrhage, MELD 24.
C. Medical therapy with vasoactive drugs
Variant 4: Acute variceal bleeding. Child-Pugh class C, cirrhotic with hepatocellular carcinoma, branch portal vein tumor thrombus, and active esophageal and gastroesophageal type 1 (GOV1) variceal hemorrhage, MELD 24.
D. Percutaneous transhepatic embolization
Variant 4: Acute variceal bleeding. Child-Pugh class C, cirrhotic with hepatocellular carcinoma, branch portal vein tumor thrombus, and active esophageal and gastroesophageal type 1 (GOV1) variceal hemorrhage, MELD 24.
E. Surgical shunt
Variant 4: Acute variceal bleeding. Child-Pugh class C, cirrhotic with hepatocellular carcinoma, branch portal vein tumor thrombus, and active esophageal and gastroesophageal type 1 (GOV1) variceal hemorrhage, MELD 24.
F. Transjugular intrahepatic portosystemic shunt
Variant 5: Ascites. Initial therapy for Child-Pugh class B cirrhotic asymptomatic patient with small-volume ascites.
Variant 5: Ascites. Initial therapy for Child-Pugh class B cirrhotic asymptomatic patient with small-volume ascites.
A. Large-volume paracentesis
Variant 5: Ascites. Initial therapy for Child-Pugh class B cirrhotic asymptomatic patient with small-volume ascites.
B. Medical therapy and dietary modification
Variant 5: Ascites. Initial therapy for Child-Pugh class B cirrhotic asymptomatic patient with small-volume ascites.
C. Peritoneovenous shunt
Variant 5: Ascites. Initial therapy for Child-Pugh class B cirrhotic asymptomatic patient with small-volume ascites.
D. Transjugular intrahepatic portosystemic shunt
Variant 5: Ascites. Initial therapy for Child-Pugh class B cirrhotic asymptomatic patient with small-volume ascites.
E. Volume expansion
Variant 6: Ascites. Child-Pugh class B cirrhotic with chronic ascites despite daily diuretic therapy and low-sodium diet.
Variant 6: Ascites. Child-Pugh class B cirrhotic with chronic ascites despite daily diuretic therapy and low-sodium diet.
A. Large-volume paracentesis
Variant 6: Ascites. Child-Pugh class B cirrhotic with chronic ascites despite daily diuretic therapy and low-sodium diet.
B. Medical therapy and dietary modification
Variant 6: Ascites. Child-Pugh class B cirrhotic with chronic ascites despite daily diuretic therapy and low-sodium diet.
C. Peritoneovenous shunt
Variant 6: Ascites. Child-Pugh class B cirrhotic with chronic ascites despite daily diuretic therapy and low-sodium diet.
D. Transjugular intrahepatic portosystemic shunt
Variant 6: Ascites. Child-Pugh class B cirrhotic with chronic ascites despite daily diuretic therapy and low-sodium diet.
E. Volume expansion
Variant 7: Ascites. Child-Pugh class B cirrhotic with chronic ascites undergoing weekly large-volume paracentesis; rapidly declining renal function unresponsive to diuretic withdrawal.
Variant 7: Ascites. Child-Pugh class B cirrhotic with chronic ascites undergoing weekly large-volume paracentesis; rapidly declining renal function unresponsive to diuretic withdrawal.
A. Large-volume paracentesis
Variant 7: Ascites. Child-Pugh class B cirrhotic with chronic ascites undergoing weekly large-volume paracentesis; rapidly declining renal function unresponsive to diuretic withdrawal.
B. Medical therapy and dietary modification
Variant 7: Ascites. Child-Pugh class B cirrhotic with chronic ascites undergoing weekly large-volume paracentesis; rapidly declining renal function unresponsive to diuretic withdrawal.
C. Peritoneovenous shunt
Variant 7: Ascites. Child-Pugh class B cirrhotic with chronic ascites undergoing weekly large-volume paracentesis; rapidly declining renal function unresponsive to diuretic withdrawal.
D. Transjugular intrahepatic portosystemic shunt
Variant 7: Ascites. Child-Pugh class B cirrhotic with chronic ascites undergoing weekly large-volume paracentesis; rapidly declining renal function unresponsive to diuretic withdrawal.
E. Volume expansion
Summary of Highlights
Supporting Documents

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Appropriateness Category Names and Definitions

Appropriateness Category Name

Appropriateness Rating

Appropriateness Category Definition

Usually Appropriate

7, 8, or 9

The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.

May Be Appropriate

4, 5, or 6

The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.

May Be Appropriate (Disagreement)

5

The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.

Usually Not Appropriate

1, 2, or 3

The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.
References
1. Bosch J, Berzigotti A, Garcia-Pagan JC, Abraldes JG. The management of portal hypertension: rational basis, available treatments and future options. J Hepatol. 2008;48 Suppl 1:S68-92.
2. Bari K, Garcia-Tsao G. Treatment of portal hypertension. World J Gastroenterol. 2012;18(11):1166-1175.
3. Kim CY, Pinchot JW, Ahmed O, et al. ACR Appropriateness Criteria® Radiologic Management of Gastric Varices. J Am Coll Radiol 2020;17:S239-S54.
4. Schmidt ML, Barritt AS, Orman ES, Hayashi PH. Decreasing mortality among patients hospitalized with cirrhosis in the United States from 2002 through 2010. Gastroenterology. 2015;148(5):967-977 e962.
5. Gines P, Quintero E, Arroyo V, et al. Compensated cirrhosis: natural history and prognostic factors. Hepatology. 1987;7(1):122-128.
6. D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44(1):217-231.
7. Planas R, Montoliu S, Balleste B, et al. Natural history of patients hospitalized for management of cirrhotic ascites. Clin Gastroenterol Hepatol. 2006;4(11):1385-1394.
8. D'Amico G, Luca A. Natural history. Clinical-haemodynamic correlations. Prediction of the risk of bleeding. Baillieres Clin Gastroenterol. 1997;11(2):243-256.
9. Runyon BA. Refractory ascites. Semin Liver Dis. 1993;13(4):343-351.
10. Russo MW, Sood A, Jacobson IM, Brown RS, Jr. Transjugular intrahepatic portosystemic shunt for refractory ascites: an analysis of the literature on efficacy, morbidity, and mortality. Am J Gastroenterol. 2003;98(11):2521-2527.
11. Gines P, Guevara M, Arroyo V, Rodes J. Hepatorenal syndrome. Lancet 2003;362:1819-27.
12. Gines P, Schrier RW. Renal failure in cirrhosis. N Engl J Med 2009;361:1279-90.
13. Salerno F, Gerbes A, Gines P, Wong F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut. 2007;56(9):1310-1318.
14. Salerno F, Gerbes A, Gines P, Wong F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Postgrad Med J. 2008;84(998):662-670.
15. Abraldes JG, Villanueva C, Banares R, et al. Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy. J Hepatol. 2008;48(2):229-236.
16. Bosch J, Groszmann RJ, Shah VH. Evolution in the understanding of the pathophysiological basis of portal hypertension: How changes in paradigm are leading to successful new treatments. J Hepatol. 2015;62(1 Suppl):S121-130.
17. Silva-Junior G, Baiges A, Turon F, et al. The prognostic value of hepatic venous pressure gradient in patients with cirrhosis is highly dependent on the accuracy of the technique. Hepatology. 2015;62(5):1584-1592.
18. D'Amico G, Garcia-Pagan JC, Luca A, Bosch J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology. 2006;131(5):1611-1624.
19. Horowitz JM, Kamel IR, Arif-Tiwari H, et al. ACR Appropriateness Criteria R Chronic Liver Disease. J. Am. Coll. Radiol.. 14(11S):S391-S405, 2017 Nov.
20. Wells M, Chande N, Adams P, et al. Meta-analysis: vasoactive medications for the management of acute variceal bleeds. Aliment Pharmacol Ther. 2012;35(11):1267-1278.
21. Avgerinos A, Nevens F, Raptis S, Fevery J. Early administration of somatostatin and efficacy of sclerotherapy in acute oesophageal variceal bleeds: the European Acute Bleeding Oesophageal Variceal Episodes (ABOVE) randomised trial. Lancet. 1997;350(9090):1495-1499.
22. Cales P, Masliah C, Bernard B, et al. Early administration of vapreotide for variceal bleeding in patients with cirrhosis. N Engl J Med. 2001;344(1):23-28.
23. Garcia-Pagan JC, Reverter E, Abraldes JG, Bosch J. Acute variceal bleeding. Semin Respir Crit Care Med. 2012;33(1):46-54.
24. Levacher S, Letoumelin P, Pateron D, Blaise M, Lapandry C, Pourriat JL. Early administration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients. Lancet. 1995;346(8979):865-868.
25. Villanueva C, Ortiz J, Sabat M, et al. Somatostatin alone or combined with emergency sclerotherapy in the treatment of acute esophageal variceal bleeding: a prospective randomized trial. Hepatology. 1999;30(2):384-389.
26. Banares R, Albillos A, Rincon D, et al. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology. 2002;35(3):609-615.
27. Wang C, Han J, Xiao L, Jin CE, Li DJ, Yang Z. Efficacy of vasopressin/terlipressin and somatostatin/octreotide for the prevention of early variceal rebleeding after the initial control of bleeding: a systematic review and meta-analysis. Hepatol Int. 2015;9(1):120-129.
28. Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L. Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding. Cochrane Database Syst Rev 2002:CD002907.
29. Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila F, et al. Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding - an updated Cochrane review. Aliment Pharmacol Ther 2011;34:509-18.
30. de Franchis R. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63(3):743-752.
31. Lo GH, Chen WC, Wang HM, et al. Low-dose terlipressin plus banding ligation versus low-dose terlipressin alone in the prevention of very early rebleeding of oesophageal varices. Gut. 2009;58(9):1275-1280.
32. Lo GH, Lai KH, Cheng JS, et al. A prospective, randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices. Hepatology. 1995;22(2):466-471.
33. Masci E, Stigliano R, Mariani A, et al. Prospective multicenter randomized trial comparing banding ligation with sclerotherapy of esophageal varices. Hepatogastroenterology. 1999;46(27):1769-1773.
34. Van Stiegmann G, Isshi K. Elastic band ligation for bleeding esophagogastric varices. Hepatogastroenterology. 1997;44(15):620-624.
35. Ferrari AP, de Paulo GA, de Macedo CM, Araujo I, Della Libera E, Jr. Efficacy of absolute alcohol injection compared with band ligation in the eradication of esophageal varices. Arq Gastroenterol. 2005;42(2):72-76.
36. Santos MM, Tolentino LH, Rodrigues RA, et al. Endoscopic treatment of esophageal varices in advanced liver disease patients: band ligation versus cyanoacrylate injection. Eur J Gastroenterol Hepatol. 2011;23(1):60-65.
37. Villanueva C, Piqueras M, Aracil C, et al. A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding. J Hepatol. 2006;45(4):560-567.
38. Laine L, Cook D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis. Ann Intern Med. 1995;123(4):280-287.
39. Ohmoto K, Yoshioka N, Tomiyama Y, et al. Improved prognosis of cirrhosis patients with esophageal varices and thrombocytopenia treated by endoscopic variceal ligation plus partial splenic embolization. Dig Dis Sci. 2006;51(2):352-358.
40. Taniai N, Onda M, Tajiri T, Toba M, Yoshida H. Endoscopic variceal ligation (EVL) combined with partial splenic embolization (PSE). Hepatogastroenterology. 1999;46(29):2849-2853.
41. Taniai N, Onda M, Tajiri T, Yoshida H, Mamada Y. Combined endoscopic and radiologic intervention to treat esophageal varices. Hepatogastroenterology. 2002;49(46):984-988.
42. D'Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: a meta-analytic review. Hepatology. 1995;22(1):332-354.
43. Jalan R, John TG, Redhead DN, et al. A comparative study of emergency transjugular intrahepatic portosystemic stent-shunt and esophageal transection in the management of uncontrolled variceal hemorrhage. The American journal of gastroenterology 1995;90:1932-7.
44. Henderson JM. Variceal bleeding: which shunt? Gastroenterology. 1986;91(4):1021-1023.
45. Zakim D, Boyer TD. Hepatology : a textbook of liver disease. 4th ed. Philadelphia: Saunders; 2003.
46. Rosemurgy AS, Frohman HA, Teta AF, Luberice K, Ross SB. Prosthetic H-graft portacaval shunts vs transjugular intrahepatic portasystemic stent shunts: 18-year follow-up of a randomized trial. J Am Coll Surg. 2012;214(4):445-453; discussion 453-445.
47. Henderson JM, Boyer TD, Kutner MH, et al. Distal splenorenal shunt versus transjugular intrahepatic portal systematic shunt for variceal bleeding: a randomized trial. Gastroenterology. 2006;130(6):1643-1651.
48. Clark W, Hernandez J, McKeon B, et al. Surgical shunting versus transjugular intrahepatic portasystemic shunting for bleeding varices resulting from portal hypertension and cirrhosis: a meta-analysis. Am Surg. 2010;76(8):857-864.
49. Cabrera J, Maynar M, Granados R, et al. Transjugular intrahepatic portosystemic shunt versus sclerotherapy in the elective treatment of variceal hemorrhage. Gastroenterology. 1996;110(3):832-839.
50. Cello JP, Ring EJ, Olcott EW, et al. Endoscopic sclerotherapy compared with percutaneous transjugular intrahepatic portosystemic shunt after initial sclerotherapy in patients with acute variceal hemorrhage. A randomized, controlled trial. Ann Intern Med. 1997;126(11):858-865.
51. Jalan R, Forrest EH, Stanley AJ, et al. A randomized trial comparing transjugular intrahepatic portosystemic stent-shunt with variceal band ligation in the prevention of rebleeding from esophageal varices. Hepatology. 1997;26(5):1115-1122.
52. Merli M, Salerno F, Riggio O, et al. Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotherapy for the prevention of variceal bleeding in cirrhosis: a randomized multicenter trial. Gruppo Italiano Studio TIPS (G.I.S.T.). Hepatology. 1998;27(1):48-53.
53. Rossle M, Deibert P, Haag K, et al. Randomised trial of transjugular-intrahepatic-portosystemic shunt versus endoscopy plus propranolol for prevention of variceal rebleeding. Lancet. 1997;349(9058):1043-1049.
54. Sanyal AJ, Freedman AM, Luketic VA, et al. Transjugular intrahepatic portosystemic shunts compared with endoscopic sclerotherapy for the prevention of recurrent variceal hemorrhage. A randomized, controlled trial. Ann Intern Med. 1997;126(11):849-857.
55. Sauer P, Theilmann L, Stremmel W, Benz C, Richter GM, Stiehl A. Transjugular intrahepatic portosystemic stent shunt versus sclerotherapy plus propranolol for variceal rebleeding. Gastroenterology. 1997;113(5):1623-1631.
56. Luca A, D'Amico G, La Galla R, Midiri M, Morabito A, Pagliaro L. TIPS for prevention of recurrent bleeding in patients with cirrhosis: meta-analysis of randomized clinical trials. Radiology. 1999;212(2):411-421.
57. Papatheodoridis GV, Goulis J, Leandro G, Patch D, Burroughs AK. Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding: A meta-analysis. Hepatology. 1999;30(3):612-622.
58. Garcia-Pagan JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010;362(25):2370-2379.
59. Monescillo A, Martinez-Lagares F, Ruiz-del-Arbol L, et al. Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding. Hepatology. 2004;40(4):793-801.
60. Angeloni S, Merli M, Salvatori FM, et al. Polytetrafluoroethylene-covered stent grafts for TIPS procedure: 1-year patency and clinical results. Am J Gastroenterol. 2004;99(2):280-285.
61. Angermayr B, Cejna M, Koenig F, et al. Survival in patients undergoing transjugular intrahepatic portosystemic shunt: ePTFE-covered stentgrafts versus bare stents. Hepatology. 2003;38(4):1043-1050.
62. Bureau C, Pagan JC, Layrargues GP, et al. Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomized multicentre study. Liver Int. 2007;27(6):742-747.
63. Jung HS, Kalva SP, Greenfield AJ, et al. TIPS: comparison of shunt patency and clinical outcomes between bare stents and expanded polytetrafluoroethylene stent-grafts. J Vasc Interv Radiol. 2009;20(2):180-185.
64. Rossi P, Salvatori FM, Fanelli F, et al. Polytetrafluoroethylene-covered nitinol stent-graft for transjugular intrahepatic portosystemic shunt creation: 3-year experience. Radiology. 2004;231(3):820-830.
65. Saad WE, Darwish WM, Davies MG, Waldman DL. Stent-grafts for transjugular intrahepatic portosystemic shunt creation: specialized TIPS stent-graft versus generic stent-graft/bare stent combination. J Vasc Interv Radiol. 2010;21(10):1512-1520.
66. Garcia-Pagan JC, Di Pascoli M, Caca K, et al. Use of early-TIPS for high-risk variceal bleeding: results of a post-RCT surveillance study. J Hepatol. 2013;58(1):45-50.
67. Rudler M, Rousseau G, Thabut D. Salvage transjugular intrahepatic portosystemic shunt followed by early transplantation in patients with Child C14-15 cirrhosis and refractory variceal bleeding: a strategy improving survival. Transpl Int. 2013;26(6):E50-51.
68. Halabi SA, Sawas T, Sadat B, et al. Early TIPS versus endoscopic therapy for secondary prophylaxis after management of acute esophageal variceal bleeding in cirrhotic patients: a meta-analysis of randomized controlled trials. Journal of Gastroenterology & Hepatology. 31(9):1519-26, 2016 Sep.J Gastroenterol Hepatol. 31(9):1519-26, 2016 Sep.
69. Pomier-Layrargues G, Villeneuve JP, Deschenes M, et al. Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial. Gut. 2001;48(3):390-396.
70. Rosemurgy AS, Bloomston M, Clark WC, Thometz DP, Zervos EE. H-graft portacaval shunts versus TIPS: ten-year follow-up of a randomized trial with comparison to predicted survivals. Ann Surg 2005;241:238-46.
71. Augustin S, Altamirano J, Gonzalez A, et al. Effectiveness of combined pharmacologic and ligation therapy in high-risk patients with acute esophageal variceal bleeding. The American journal of gastroenterology 2011;106:1787-95.
72. Reverter E, Tandon P, Augustin S, et al. A MELD-based model to determine risk of mortality among patients with acute variceal bleeding. Gastroenterology. 2014;146(2):412-419 e413.
73. Conejo I, Guardascione MA, Tandon P, et al. Multicenter External Validation of Risk Stratification Criteria for Patients With Variceal Bleeding. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2018;16:132-39 e8.
74. Al Sibae MR, Cappell MS. Accuracy of MELD scores in predicting mortality in decompensated cirrhosis from variceal bleeding, hepatorenal syndrome, alcoholic hepatitis, or acute liver failure as well as mortality after non-transplant surgery or TIPS. Dig Dis Sci 2011;56:977-87.
75. Casadaban LC, Parvinian A, Zivin SP, et al. MELD score for prediction of survival after emergent TIPS for acute variceal hemorrhage: derivation and validation in a 101-patient cohort. Ann Hepatol 2015;14:380-8.
76. Gaba RC, Couture PM, Bui JT, et al. Prognostic capability of different liver disease scoring systems for prediction of early mortality after transjugular intrahepatic portosystemic shunt creation. Journal of vascular and interventional radiology : JVIR 2013;24:411-20, 20 e1-4; quiz 21.
77. Heinzow HS, Lenz P, Kohler M, et al. Clinical outcome and predictors of survival after TIPS insertion in patients with liver cirrhosis. World J Gastroenterol 2012;18:5211-8.
78. Montgomery A, Ferral H, Vasan R, Postoak DW. MELD score as a predictor of early death in patients undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) procedures. Cardiovascular and interventional radiology 2005;28:307-12.
79. Tzeng WS, Wu RH, Lin CY, et al. Prediction of mortality after emergent transjugular intrahepatic portosystemic shunt placement: use of APACHE II, Child-Pugh and MELD scores in Asian patients with refractory variceal hemorrhage. Korean J Radiol 2009;10:481-9.
80. Dechene A, El Fouly AH, Bechmann LP, et al. Acute management of refractory variceal bleeding in liver cirrhosis by self-expanding metal stents. Digestion. 2012;85(3):185-191.
81. Fierz FC, Kistler W, Stenz V, Gubler C. Treatment of esophageal variceal hemorrhage with self-expanding metal stents as a rescue maneuver in a swiss multicentric cohort. Case Rep Gastroenterol. 2013;7(1):97-105.
82. Wright G, Lewis H, Hogan B, Burroughs A, Patch D, O'Beirne J. A self-expanding metal stent for complicated variceal hemorrhage: experience at a single center. Gastrointest Endosc. 2010;71(1):71-78.
83. Zakaria MS, Hamza IM, Mohey MA, Hubamnn RG. The first Egyptian experience using new self-expandable metal stents in acute esophageal variceal bleeding: pilot study. Saudi J Gastroenterol. 2013;19(4):177-181.
84. Zehetner J, Shamiyeh A, Wayand W, Hubmann R. Results of a new method to stop acute bleeding from esophageal varices: implantation of a self-expanding stent. Surg Endosc. 2008;22(10):2149-2152.
85. Hermie L, Dhondt E, Vanlangenhove P, Hoste E, Geerts A, Defreyne L. Model for end-stage liver disease score and hemodynamic instability as a predictor of poor outcome in early transjugular intrahepatic portosystemic shunt treatment for acute variceal hemorrhage. European Journal of Gastroenterology & Hepatology. 30(12):1441-1446, 2018 12.Eur J Gastroenterol Hepatol. 30(12):1441-1446, 2018 12.
86. D'Amico G, De Franchis R, Cooperative Study G. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology 2003;38:599-612.
87. Englesbe MJ, Kubus J, Muhammad W, et al. Portal vein thrombosis and survival in patients with cirrhosis. Liver Transpl 2010;16:83-90.
88. Wong F, Blendis L. Transjugular intrahepatic portosystemic shunt for refractory ascites: tipping the sodium balance. Hepatology 1995;22:358-64.
89. Bilbao JI, Quiroga J, Herrero JI, Benito A. Transjugular intrahepatic portosystemic shunt (TIPS): current status and future possibilities. Cardiovascular and interventional radiology 2002;25:251-69.
90. Nunes EL, dos Santos KR, Mondino PJ, Bastos Mdo C, Giambiagi-deMarval M. Detection of ileS-2 gene encoding mupirocin resistance in methicillin-resistant Staphylococcus aureus by multiplex PCR. Diagn Microbiol Infect Dis 1999;34:77-81.
91. Ochs A. Transjugular intrahepatic portosystemic shunt. Dig Dis 2005;23:56-64.
92. Senzolo M, Cholongitas E, Davies N, et al. Transjugular Intrahepatic Portosystemic Shunt (TIPS), the preferred therapeutic option for Budd Chiari syndrome associated with portal vein thrombosis. The American journal of gastroenterology 2006;101:2163-4; author reply 64-5.
93. Senzolo M, Tibbals J, Cholongitas E, Triantos CK, Burroughs AK, Patch D. Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with and without cavernous transformation. Alimentary pharmacology & therapeutics 2006;23:767-75.
94. Valentin N, Korrapati P, Constantino J, Young A, Weisberg I. The role of transjugular intrahepatic portosystemic shunt in the management of portal vein thrombosis: a systematic review and meta-analysis. European journal of gastroenterology & hepatology 2018;30:1187-93.
95. Lunderquist A, Vang J. Sclerosing injection of esophageal varices through transhepatic selective catheterization of the gastric coronary vein. A preliminary report. Acta Radiol Diagn (Stockh) 1974;15:546-50.
96. Tian X, Shi Y, Hu J, Wang G, Zhang C. Percutaneous transhepatic variceal embolization with cyanoacrylate vs. transjugular intrahepatic portal systematic shunt for esophageal variceal bleeding. Hepatology international 2013;7:636-44.
97. Chu HH, Kim HC, Jae HJ, et al. Percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver disease. Cardiovascular & Interventional Radiology. 35(6):1388-95, 2012 Dec.Cardiovasc Intervent Radiol. 35(6):1388-95, 2012 Dec.
98. Gong GQ, Wang XL, Wang JH, et al. Percutaneous transsplenic embolization of esophageal and gastrio-fundal varices in 18 patients. World J Gastroenterol 2001;7:880-3.
99. Tuite DJ, Rehman J, Davies MH, Patel JV, Nicholson AA, Kessel DO. Percutaneous transsplenic access in the management of bleeding varices from chronic portal vein thrombosis. J Vasc Interv Radiol 2007;18:1571-5.
100. Trotter J, Pieramici E, Everson GT. Chronic albumin infusions to achieve diuresis in patients with ascites who are not candidates for transjugular intrahepatic portosystemic shunt (TIPS). Dig Dis Sci. 2005;50(7):1356-1360.
101. Wong F. Management of ascites in cirrhosis. J Gastroenterol Hepatol. 2012;27(1):11-20.
102. Barbano B, Sardo L, Gigante A, et al. Pathophysiology, diagnosis and clinical management of hepatorenal syndrome: from classic to new drugs. Curr Vasc Pharmacol. 2014;12(1):125-135.
103. Fernandez J, Monteagudo J, Bargallo X, et al. A randomized unblinded pilot study comparing albumin versus hydroxyethyl starch in spontaneous bacterial peritonitis. Hepatology. 2005;42(3):627-634.
104. Guevara M, Arroyo V. Hepatorenal syndrome. Expert Opin Pharmacother. 2011;12(9):1405-1417.
105. Gentilini P, Casini-Raggi V, Di Fiore G, et al. Albumin improves the response to diuretics in patients with cirrhosis and ascites: results of a randomized, controlled trial. J Hepatol. 1999;30(4):639-645.
106. Romanelli RG, La Villa G, Barletta G, et al. Long-term albumin infusion improves survival in patients with cirrhosis and ascites: an unblinded randomized trial. World J Gastroenterol. 2006;12(9):1403-1407.
107. Wong F, Watson H, Gerbes A, et al. Satavaptan for the management of ascites in cirrhosis: efficacy and safety across the spectrum of ascites severity. Gut 2012;61:108-16.
108. Gines P, Wong F, Watson H, Milutinovic S, del Arbol LR, Olteanu D. Effects of satavaptan, a selective vasopressin V(2) receptor antagonist, on ascites and serum sodium in cirrhosis with hyponatremia: a randomized trial. Hepatology. 2008;48(1):204-213.
109. Gines P, Wong F, Watson H, et al. Clinical trial: short-term effects of combination of satavaptan, a selective vasopressin V2 receptor antagonist, and diuretics on ascites in patients with cirrhosis without hyponatraemia--a randomized, double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2010;31(8):834-845.
110. Wong F, Gines P, Watson H, et al. Effects of a selective vasopressin V2 receptor antagonist, satavaptan, on ascites recurrence after paracentesis in patients with cirrhosis. J Hepatol. 2010;53(2):283-290.
111. Serste T, Melot C, Francoz C, et al. Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology 2010;52:1017-22.
112. Arroyo V, Gines P, Gerbes AL, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology. 1996;23(1):164-176.
113. Gines P, Arroyo V, Vargas V, et al. Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites. N Engl J Med. 1991;325(12):829-835.
114. Moore KP, Wong F, Gines P, et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology. 2003;38(1):258-266.
115. Runyon BA. Management of adult patients with ascites due to cirrhosis: an update. Hepatology. 2009;49(6):2087-2107.
116. Bai M, Qi XS, Yang ZP, Yang M, Fan DM, Han GH. TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites: an updated meta-analysis. World J Gastroenterol. 2014;20(10):2704-2714.
117. Gines P, Arroyo V, Quintero E, et al. Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study. Gastroenterology. 1987;93(2):234-241.
118. Salerno F, Badalamenti S, Incerti P, et al. Repeated paracentesis and i.v. albumin infusion to treat 'tense' ascites in cirrhotic patients. A safe alternative therapy. J Hepatol. 1987;5(1):102-108.
119. Gines P, Tito L, Arroyo V, et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology. 1988;94(6):1493-1502.
120. Pozzi M, Osculati G, Boari G, et al. Time course of circulatory and humoral effects of rapid total paracentesis in cirrhotic patients with tense, refractory ascites. Gastroenterology. 1994;106(3):709-719.
121. Ruiz-del-Arbol L, Monescillo A, Jimenez W, Garcia-Plaza A, Arroyo V, Rodes J. Paracentesis-induced circulatory dysfunction: mechanism and effect on hepatic hemodynamics in cirrhosis. Gastroenterology. 1997;113(2):579-586.
122. Appenrodt B, Wolf A, Grunhage F, et al. Prevention of paracentesis-induced circulatory dysfunction: midodrine vs albumin. A randomized pilot study. Liver Int. 2008;28(7):1019-1025.
123. Gines A, Fernandez-Esparrach G, Monescillo A, et al. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology. 1996;111(4):1002-1010.
124. Planas R, Gines P, Arroyo V, et al. Dextran-70 versus albumin as plasma expanders in cirrhotic patients with tense ascites treated with total paracentesis. Results of a randomized study. Gastroenterology. 1990;99(6):1736-1744.
125. Sola-Vera J, Minana J, Ricart E, et al. Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites. Hepatology. 2003;37(5):1147-1153.
126. Moreau R, Valla DC, Durand-Zaleski I, et al. Comparison of outcome in patients with cirrhosis and ascites following treatment with albumin or a synthetic colloid: a randomised controlled pilot trail. Liver Int. 2006;26(1):46-54.
127. Salerno F, Guevara M, Bernardi M, et al. Refractory ascites: pathogenesis, definition and therapy of a severe complication in patients with cirrhosis. Liver Int. 2010;30(7):937-947.
128. Lata J, Marecek Z, Fejfar T, et al. The efficacy of terlipressin in comparison with albumin in the prevention of circulatory changes after the paracentesis of tense ascites--a randomized multicentric study. Hepatogastroenterology. 2007;54(79):1930-1933.
129. Moreau R, Asselah T, Condat B, et al. Comparison of the effect of terlipressin and albumin on arterial blood volume in patients with cirrhosis and tense ascites treated by paracentesis: a randomised pilot study. Gut. 2002;50(1):90-94.
130. Singh V, Kumar R, Nain CK, Singh B, Sharma AK. Terlipressin versus albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized study. J Gastroenterol Hepatol. 2006;21(1 Pt 2):303-307.
131. Singh V, Dheerendra PC, Singh B, et al. Midodrine versus albumin in the prevention of paracentesis-induced circulatory dysfunction in cirrhotics: a randomized pilot study. Am J Gastroenterol. 2008;103(6):1399-1405.
132. Lebrec D, Giuily N, Hadengue A, et al. Transjugular intrahepatic portosystemic shunts: comparison with paracentesis in patients with cirrhosis and refractory ascites: a randomized trial. French Group of Clinicians and a Group of Biologists. J Hepatol. 1996;25(2):135-144.
133. Rossle M, Ochs A, Gulberg V, et al. A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N Engl J Med. 2000;342(23):1701-1707.
134. Sanyal AJ, Genning C, Reddy KR, et al. The North American Study for the Treatment of Refractory Ascites. Gastroenterology. 2003;124(3):634-641.
135. Gines P, Uriz J, Calahorra B, et al. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. Gastroenterology. 2002;123(6):1839-1847.
136. Narahara Y, Kanazawa H, Fukuda T, et al. Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function: a prospective randomized trial. J Gastroenterol. 2011;46(1):78-85.
137. Salerno F, Merli M, Riggio O, et al. Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites. Hepatology. 2004;40(3):629-635.
138. Leveen HH, Christoudias G, Ip M, Luft R, Falk G, Grosberg S. Peritoneo-venous shunting for ascites. Ann Surg. 1974;180(4):580-591.
139. Martin LG. Percutaneous placement and management of the Denver shunt for portal hypertensive ascites. AJR Am J Roentgenol. 2012;199(4):W449-453.
140. Bratby MJ, Hussain FF, Lopez AJ. Radiological insertion and management of peritoneovenous shunt. Cardiovasc Intervent Radiol. 2007;30(3):415-418.
141. Foroulis CN, Desimonas NA. Massive pneumoperitoneum: a late complication of the Denver pleuroperitoneal shunt. Ann Thorac Surg. 2005;80(4):e13.
142. Lopez-Viego MA, Cornell JM. Pneumoperitoneum and signs of peritonitis from a pleuroperitoneal shunt. Surgery. 1992;111(2):228-229.
143. Rosemurgy AS, Zervos EE, Clark WC, et al. TIPS versus peritoneovenous shunt in the treatment of medically intractable ascites: a prospective randomized trial. Ann Surg. 2004;239(6):883-889; discussion 889-891.
144. Zervos EE, Rosemurgy AS. Management of medically refractory ascites. Am J Surg. 2001;181(3):256-264.
145. Boyer TD, Sanyal AJ, Wong F, et al. Terlipressin Plus Albumin Is More Effective Than Albumin Alone in Improving Renal Function in Patients With Cirrhosis and Hepatorenal Syndrome Type 1. Gastroenterology 2016;150:1579-89 e2.
146. Gifford FJ, Morling JR, Fallowfield JA. Systematic review with meta-analysis: vasoactive drugs for the treatment of hepatorenal syndrome type 1. Aliment Pharmacol Ther 2017;45:593-603.
147. Amin AA, Alabsawy EI, Jalan R, Davenport A. Epidemiology, Pathophysiology, and Management of Hepatorenal Syndrome. Semin Nephrol 2019;39:17-30.
148. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010;53:397-417.
149. Runyon BA, Aasld. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology 2013;57:1651-3.
150. Colle I, Laterre PF. Hepatorenal syndrome: the clinical impact of vasoactive therapy. Expert Rev Gastroenterol Hepatol 2018;12:173-88.
151. Cavallin M, Kamath PS, Merli M, et al. Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: A randomized trial. Hepatology 2015;62:567-74.
152. Sharma P, Kumar A, Shrama BC, Sarin SK. An open label, pilot, randomized controlled trial of noradrenaline versus terlipressin in the treatment of type 1 hepatorenal syndrome and predictors of response. Am J Gastroenterol 2008;103:1689-97.
153. Ghosh S, Choudhary NS, Sharma AK, et al. Noradrenaline vs terlipressin in the treatment of type 2 hepatorenal syndrome: a randomized pilot study. Liver Int 2013;33:1187-93.
154. Sanyal AJ, Boyer TD, Frederick RT, et al. Reversal of hepatorenal syndrome type 1 with terlipressin plus albumin vs. placebo plus albumin in a pooled analysis of the OT-0401 and REVERSE randomised clinical studies. Aliment Pharmacol Ther 2017;45:1390-402.
155. Boyer TD, Sanyal AJ, Garcia-Tsao G, et al. Predictors of response to terlipressin plus albumin in hepatorenal syndrome (HRS) type 1: relationship of serum creatinine to hemodynamics. J Hepatol 2011;55:315-21.
156. Sanyal AJ, Boyer T, Garcia-Tsao G, et al. A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome. Gastroenterology 2008;134:1360-8.
157. Neri S, Pulvirenti D, Malaguarnera M, et al. Terlipressin and albumin in patients with cirrhosis and type I hepatorenal syndrome. Dig Dis Sci 2008;53:830-5.
158. Solanki P, Chawla A, Garg R, Gupta R, Jain M, Sarin SK. Beneficial effects of terlipressin in hepatorenal syndrome: a prospective, randomized placebo-controlled clinical trial. J Gastroenterol Hepatol 2003;18:152-6.
159. Sridharan K, Sivaramakrishnan G. Vasoactive Agents for Hepatorenal Syndrome: A Mixed Treatment Comparison Network Meta-Analysis and Trial Sequential Analysis of Randomized Clinical Trials. J Gen Intern Med 2018;33:97-102.
160. Salerno F, Navickis RJ, Wilkes MM. Albumin treatment regimen for type 1 hepatorenal syndrome: a dose-response meta-analysis. BMC Gastroenterol 2015;15:167.
161. Brensing KA, Textor J, Perz J, et al. Long term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study. Gut. 2000;47(2):288-295.
162. Guevara M, Gines P, Bandi JC, et al. Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: effects on renal function and vasoactive systems. Hepatology. 1998;28(2):416-422.
163. Lake JR, Ring E, LaBerge J, Gordon R, Roberts J, Ascher N. Transjugular intrahepatic portacaval stent shunts in patients with renal insufficiency. Transplant Proc. 1993;25(2):1766-1767.
164. Testino G, Ferro C, Sumberaz A, et al. Type-2 hepatorenal syndrome and refractory ascites: role of transjugular intrahepatic portosystemic stent-shunt in eighteen patients with advanced cirrhosis awaiting orthotopic liver transplantation. Hepatogastroenterology. 2003;50(54):1753-1755.
165. Wong F, Pantea L, Sniderman K. Midodrine, octreotide, albumin, and TIPS in selected patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology. 2004;40(1):55-64.
166. Linas SL, Schaefer JW, Moore EE, Good JT, Jr., Giansiracusa R. Peritoneovenous shunt in the management of the hepatorenal syndrome. Kidney Int 1986;30:736-40.
Disclaimer

The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.