Saving the life of a patient with end-stage cirrhosis using complex vascular intervention techniques

Patient D.D.Th., 46 years old, alcoholic cirrhosis, multiple gastrointestinal bleeding due to esophageal varices and gastric fundus. Previously, he had undergone endoscopic rubber band ligation and transhepatic variceal embolization (ATO). This time, the patient was hospitalized with recurrent gastrointestinal bleeding, severe ascites, edema of both lower limbs and abdominal pain.

After a multidisciplinary consultation with Gastroenterology, General Surgery and Interventional Radiology, the patient was assigned to undergo TIPS (Transjugular Intrahepatic Portosystemic Shunt). This procedure is classified by the Ministry of Health as a type I surgery, requiring high technical skills and equipment.

The team was led by Master, Doctor Nguyen Duy Thinh, Head of the Vascular Intervention Unit. The intervention lasted more than three hours, requiring absolute precision as the doctor had to create a path between the portal vein and the hepatic vein - two structures only a few millimeters apart in a cirrhotic liver.

This is an extremely difficult technique, almost like 'walking on a knife's edge'. Patients with severe cirrhosis often have blood clotting disorders, and their blood vessels are vulnerable. Just a few degrees of deviation can cause life-threatening bleeding in the liver.

Thanh Nhan Hospital became the first public hospital in Hanoi to master TIPS when successfully treating patients.

After the stent was successfully placed, the circulation between the portal vein and the vena cava was re-established, and portal vein pressure was significantly reduced. The patient was conscious, in stable health, and was being monitored in the Intensive Care Unit.

TIPS is considered a "lifesaver" for patients with end-stage cirrhosis with complications of portal hypertension - the cause of gastrointestinal bleeding, resistant ascites and hepatic pleural effusion.

In Vietnam, this technique was first deployed at Bach Mai Hospital, then expanded to major hospitals such as Cho Ray Hospital, 108 Central Military Hospital ....

This is a complex vascular intervention technique, requiring a modern digital subtraction angiography (DSA) system, a multidisciplinary team with in-depth knowledge of hepatic vascular anatomy, and a strict post-interventional resuscitation process. Therefore, for many years, TIPS has only been performed at central hospitals.

This time, Thanh Nhan Hospital became the first public hospital in Hanoi to master TIPS. In particular, the team used the Scorpion needle - a device that accurately locates the puncture line in the liver, reducing the risk of vascular damage and improving the safety of the procedure.

According to Master, Doctor Nguyen Duy Thinh, the application of this advanced equipment helps Thanh Nhan approach the technical process of the leading vascular intervention centers in the country, while affirming its ability to master specialized radiological techniques at the city level.

Thanh Nhan Hospital's mastery of the TIPS technique marks a new milestone in the process of stratification and enhancement of the capital's medical expertise. This success not only helps Hanoi residents access advanced vascular intervention techniques locally, but also contributes to significantly reducing the burden on central hospitals, shortening treatment time and travel costs for patients.

THIEN LAMB

Source: https://nhandan.vn/cuu-song-benh-nhan-xo-gan-giai-doan-cuoi-bang-ky-thuat-can-thiep-mach-phuc-tap-post913443.html