RESUMEN
La incorporación, hace ya 25 años, de la derivación portosistémica percutánea intrahepática (conocida por todos como TIPS) ha supuesto un indudable avance terapéutico en el manejo de los pacientes con sintomatología derivada de la hipertensión portal. En este artículo se pretende recordar sus orígenes así como las innovaciones técnicas posteriores que fueron añadiéndose progresivamente. Con la implantación de las prótesis cubiertas, que enfundan el trayecto parenquimatoso, se ha conseguido asegurar la permeabilidad a largo plazo de la conexión, con lo que disminuyen las necesidades de reintervención. Las sólidas evidencias obtenidas desde valiosas publicaciones sitúan el TIPS en un lugar preferente entre el compendio terapéutico de una gran variedad de situaciones clínicas asociadas a la presencia de hipertensión portal (AU)
The incorporation, 25 years ago, of transjugular intrahepatic portosystemic shunting, better known by the acronym TIPS, represents an indisputable improvement in the treatment and management of patients with symptoms due to portal hypertension. This article discusses the origins of the technique and the technical innovations that have been progressively added through the years. The implantation of coated stents, which protect the stent from processes in the parenchymal track that can lead to stenosis, have helped ensure long-term patency, thus reducing the need for reintervention. Solid evidence from valuable publications has situated TIPS at the forefront of the treatment options in a wide variety of clinical situations associated with portal hypertension (AU)
Asunto(s)
Humanos , Masculino , Femenino , Derivación Portosistémica Intrahepática Transyugular/métodos , Derivación Portosistémica Intrahepática Transyugular , Derivación Portosistémica Quirúrgica/historia , Hipertensión Portal/epidemiología , Hipertensión Portal , Cirrosis Hepática/complicaciones , Cirrosis Hepática , Derivación Portocava Quirúrgica/historia , Derivación Portocava Quirúrgica/métodos , Stents/tendencias , Derivación Portosistémica Quirúrgica/tendencias , Portografía/historia , Portografía , Embolización Terapéutica , Várices/complicaciones , Ascitis/complicacionesRESUMEN
A summary of several techniques for visualization of the portal venous system, developed in the last four decades, is given. The various methods are divided into direct and indirect techniques. Indirect arterial portography is the method of choice in patients with cirrhosis of the liver, being the most physiologic technique, visualizing the total portal venous system including arterial supply and having a low complication risk.
Asunto(s)
Flebografía/historia , Sistema Porta/diagnóstico por imagen , Angiografía/historia , Historia del Siglo XX , Humanos , Hígado/diagnóstico por imagen , Cirrosis Hepática/diagnóstico por imagen , Flebografía/métodos , Portografía/historia , Portografía/métodosRESUMEN
Proceeding from the pre-war state of the radiology of the pancreas in temporary order those investigations are discussed which essentially furthered the diagnosis of pancreatic diseases. The pneumopancreatotomography allowed the first direct proof of the pancreas; it has essentially enriched the anatomic conceptions. 10 to 15 years ago the splenoportography was the most evident examination of vessels. Today it is substituted by the coeliaco-mesentericography which in the venous phase delivers a splenoportogram and which allows to prove tumours rich in vessels with sufficient certainty. The investigation of the duodenum in hypotension improves the diagnostic of space-demanding processes on the surface of the head of the pancreas. The main value of scintigraphy consists in the exclusion of pancreatic diseases. The main value of scintigraphy consists in the exclusion of pancreatic diseases. The endoscopic retrograde cholangio-pancreaticography allows to shift the operative phase into the preoperative phase. Trijodated contrast remedies and developments concerning the technics of the apparatuses resulted in essential advantages. The pancreatic space which was empty 30 years ago is very much detected nowadays, though a contrast remedy which can be secreted by the pancreas needs still the detection.