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Abstract Details
ACR Appropriateness Criteria® Radiologic Management of Portal Hypertension
J Am Coll Radiol. 2021 May;18(5S):S153-S173.doi: 10.1016/j.jacr.2021.02.013.
Expert Panels on Interventional Radiology and Vascular Imaging; Jason W Pinchot1, Sanjeeva P Kalva2, Bill S Majdalany3, Charles Y Kim4, Osmanuddin Ahmed5, Sumeet K Asrani6, Brooks D Cash7, Jens Eldrup-Jorgensen8, A Tuba Kendi9, Matthew J Scheidt10, David M Sella11, Karin E Dill12, Eric J Hohenwalter13
Author information
1Panel Chair, University of Wisconsin, Madison, Wisconsin. Electronic address: jpinchot@uwhealth.org.
2Panel Chair, Massachusetts General Hospital, Boston, Massachusetts, Chief, Division of Interventional Radiology, Massachusetts General Hospital.
4Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina, Chief, Division of Interventional Radiology, Duke University Medical Center.
5University of Chicago, Chicago, Illinois.
6Baylor University Medical Center, Dallas, Texas, American Association for the Study of Liver Diseases.
7University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas, American Gastroenterological Association.
8Tufts University School of Medicine, Boston, Massachusetts, Society for Vascular Surgery.
9Mayo Clinic, Rochester, Minnesota, Director of Nuclear Medicine Therapy at Mayo Clinic Rochester.
10Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin.
11Mayo Clinic, Jacksonville, Florida.
12Specialty Chair, Emory University Hospital, Atlanta, Georgia.
13Specialty Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin, Chair, FMLH credentials committee, Division chief of IR at Medical College of Wisconsin.
Abstract
Cirrhosis is a heterogeneous disease that cannot be studied as a single entity and is classified in two main prognostic stages: compensated and decompensated cirrhosis. Portal hypertension, characterized by a pathological increase of the portal pressure and by the formation of portal-systemic collaterals that bypass the liver, is the initial and main consequence of cirrhosis and is responsible for the majority of its complications. A myriad of treatment options exists for appropriately managing the most common complications of portal hypertension, including acute variceal bleeding and refractory ascites. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.