Image-Guided Intervention in Managing Portal Hypertension

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after April 6, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.00
Procedures: 2.00
Abdomen and Pelvis: 2.00

Registered Radiologist Assistant: 4.50
Procedures: 4.50
Neurological, Vascular, and Lymphatic Sections: 4.50

Vascular-Interventional Radiography: 4.50
Procedures: 4.50
Vascular Interventional Procedures: 4.50

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