Complications of portal hypertension, including ascites, gastrointestinal bleeding, hepatic hydrothorax, and hepatic encephalopathy, are associated with significant morbidity and mortality.
门脉高压的并发症，包括腹水、胃肠出血、肝性胸水和肝性脑病，这些都明显与发病率和死亡率相关。
Despite few high-quality randomized controlled trials to guide therapeutic decisions, transjugular intrahepatic portosystemic shunt (TIPS) creation has emerged as a crucial therapeutic option to treat complications of portal hypertension.
尽管很少有高质量的随机对照试验来指导治疗决策，但经颈静脉肝内门静脉系统分流术(TIPS)的创建已成为治疗门静脉高压症并发症的关键治疗选择。
In North America, the decision to perform TIPS involves gastroenterologists, hepatologists, and interventional radiologists, but TIPS creation is performed by interventional radiologists.
在北美，实施TIPS的决定涉及胃肠病学家、肝脏学家和介入放射科医生，但TIPS的创建是由介入放射科医生进行的。
This is in contrast to other parts of the world where TIPS creation is performed primarily by hepatologists.
这与世界其他地方形成了对比，TIPS主要是由肝学家完成的。
Thus, the successful use of TIPS in North America is dependent on a multidisciplinary approach and technical expertise, so as to optimize outcomes.
因此，TIPS在北美的成功使用依赖于多学科的方法和技术专长，从而优化结果。
Recently, new procedural techniques, TIPS stent technology, and indications for TIPS have emerged.
最近，出现了新的手术技术、TIPS支架技术和TIPS的适应症。
As a result, practices and outcomes vary greatly across institutions and significant knowledge gaps exist.
因此，不同机构的实践和结果差异很大，并存在重大的知识差距。
In this consensus statement, the Advancing Liver Therapeutic Approaches group critically reviews the application of TIPS in the management of portal hypertension.
在这一共识声明中，先进肝治疗方法小组（ALTA）批判性地回顾了TIPS在门脉高压症管理中的应用。
Advancing Liver Therapeutic Approaches convened a multidisciplinary group of North American experts from hepatology, interventional radiology, transplant surgery, nephrology, cardiology, pulmonology, and hematology to critically review existing literature and develop practice-based recommendations for the use of TIPS in patients with any cause of portal hypertension in terms of candidate selection, procedural best practices and, post-TIPS management; and to develop areas of consensus for TIPS indications and the prevention of complications.
ALTA 召集了来自肝病、介入放射学、移植手术、肾脏学、心脏病学、肺学、肺学和血液学的多学科专家，批判性地回顾现有文献，制定病人的选择、程序最佳实践和TIPS后管理的患者中使用TIPS的建议；并制定TIPS适应症和并发症预防的共识领域。
Finally, future research directions are identified related to TIPS for the management of portal hypertension.
最后，确定了TIPS治疗门脉高压的未来研究方向。
Portal hypertension, defined as increased pressure in the portal venous system, can lead to major clinical complications including ascites, gastrointestinal hemorrhage, hepatic hydrothorax (HH), and hepatic encephalopathy (HE), all associated with significant morbidity and mortality.
门静脉高压，定义为门静脉系统的压力升高，可导致主要的临床并发症，包括腹水、胃肠道出血、肝性胸水(HH)和肝性脑病(HE)，均与显著的发病率和死亡率相关【1】。
Although medical therapies and liver transplantation (LT) are effective treatments in many scenarios（情节，剧本，事态）, transjugular intrahepatic portosystemic shunt (TIPS) creation is a crucial（关键的） therapeutic option (Supplementary Figure 1).
1虽然药物治疗和肝移植(LT)在许多情况下都是有效的治疗方法，但创建经颈静脉肝内门系统分流术(TIPS)是一个重要的治疗选择（补充图1）。
In North America, the decision to perform TIPS is determined by specialists in gastroenterology and hepatology who treat patients with portal hypertension, but TIPS creation is performed by interventional radiology (IR).
在北美，实施TIPS的决定是由治疗门脉高压患者的胃肠病学和肝学专家决定的，但TIPS的创建是通过介入放射学(IR)完成的。
This is in contrast to other parts of the world (eg, Europe) in which hepatologists primarily perform TIPS.
这与世界其他地方（如欧洲）的肝脏学家主要进行TIPS形成了鲜明对比。
Although TIPS creation is effective for management of complications of portal hypertension,【2, 3, 4, 5, 6, 7】 it is associated with several risks, including deterioration in liver function, new onset or worsening HE,8 and changes in cardiopulmonary and renal hemodynamics (Supplementary Figure 1).
虽然TIPS的产生对门脉高压并发症有效，但【2、3、4、5、6、7】与一些风险相关，包括肝功能恶化、新发或HE恶化【8】、以及心肺和肾脏血流动力学的变化（补充图1）。【9】
Over the past decade there have been important advancements in TIPS devices, procedural techniques, and immense growth in the literature supporting the role of TIPS in the management of portal hypertension.
在过去的十年中，TIPS设备、程序技术取得了重要进展，支持TIPS在门脉高压管理中的作用的文献取得了巨大增长【10,11 】。
However, there are few high-quality randomized controlled trials (RCTs) of TIPS use.
然而，关于TIPS使用的高质量随机对照试验(TCTs)却很少。
New indications for TIPS placement also have emerged, including treatment of portal vein thrombosis (PVT), which require rigorous assessment.
TIPS放置的新适应症也出现了，包括门静脉血栓形成(PVT)的治疗，这仍需要严格的评估。
As a result, practices and outcomes vary greatly across institutions and significant knowledge gaps exist.
因此，不同机构的实践和结果差异很大，并存在重大的知识差距。
The goals and objectives of the Advancing Liver Therapeutic Approaches consensus conference were to convene a multidisciplinary group of North American experts from hepatology, IR, transplant surgery, nephrology, cardiology, pulmonology, and hematology to critically review existing literature and develop practice-based recommendations for the use of TIPS in persons with any cause of portal hypertension in terms of candidate selection, procedural best practices, and post-TIPS management across 7 key topic areas: general considerations for TIPS, TIPS in the management of ascites/HH, TIPS in the management of variceal bleeding, novel indications for TIPS, cardiopulmonary considerations of TIPS including management of hepatopulmonary syndrome, renal considerations of TIPS including management of hepatorenal syndrome (HRS), and HE and TIPS.
推进肝治疗方法共识会议的目标和目标是召集一个多学科的北美专家从肝病、IR、移植手术、肾脏学、心脏病学、肺学和血液学批判性回顾现有文献和开发基于实践的建议使用的任何原因门脉高压的候选人选择，程序最佳实践，和TIPS后管理7个关键主题领域：一般考虑TIPS管理腹水/胸水，TIPS管理静脉曲张出血，TIPS的新适应症，TIPS的心肺考虑包括肝肺综合征的管理，TIPS的肾脏考虑包括肝肾综合征(HRS)的管理，以及HE和TIPS。
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