10. Transjugular intrahepatic porto-systemic shunt (TIPSS) – single tertiary care centre experience

Abstract

Background and Aims: TIPSS is a life saving procedure in cirrhotic patients with recurrent portal hypertension bleed and a palliative procedure for resistant ascites and hydrothorax. Methods: Clinical data of concurrent patients who underwent TIPSS for various indications from 2014 to 2018 was analyzed retrospectively Results: Total 16 patients underwent TIPSS during this period. Mean age was 53 (12–71) years, predominantly males (M:F:: 11:5), most common cause of underlying cirrhosis was cryptogenic. Mean MELD score was 16 (10–24), most common indication was resistant ascites (RA-10), other indications were RA+ hydrothorax (3), budd chiari syndrome with failed venous plasty (1), hepato renal syndrome (2). One of the patient had partial portal vein thrombosis and one had chronic portal vein thrombosis with large collaterals. TIPSS was placed from right hepatic vein to a collateral. In most of the patients covered stent was used except in 5, all were started on dual antiplatelets and LMWH post procedure, however stent patency rate was similar in both the groups. Most of the patients improved after the procedure, 2 patients required recurrent ascitic tapping for 3 months post TIPSS however ascites responded. 5 patients out of 16 had recurrent hepatic encephalopathy requiring admission but all of them were managed with anti coma measures, none required stent size reduction. One of them underwent liver transplant, 1 had subdural hematoma. Mean survival of our group post TIPSS was 16.6 (0.2–48) months. TIPSS patency was 100% in the study period. Conclusions: TIPSS has good survival benefits in well-chosen patients with life threatening complications related to cirrhosis. TIPSS could provide a good quality of life in those who don’t have option of liver transplant. Anticoagulation may not be a must in all patients to maintain TIPSS patency. The authors have none to declare.