Interventional radiological and surgical treatment of portal hypertension

Abstract The first-line management of portal hypertension and its complications, such as variceal bleeding and ascites, involves utilizing non-invasive medical therapies including diuretics, beta-blockers, paracentesis, and oesophagogastroduodenoscopy. However, patients may become refractory to these therapies or may develop adverse reactions or complications that preclude their use, warranting leveraging of interventional radiological and surgical techniques. This chapter discusses the technicalities, indications, complications, and outcomes of (1) interventional radiological procedures such as transjugular intrahepatic portosystemic shunts and balloon-occluded retrograde transvenous obliteration, (2) non-shunt surgical procedures, and (3) surgical portosystemic shunts, in the management of portal hypertensive complications.