Justification for the necessity of simultaneously performing transjugular intrahepatic portosystemic shunt placement and partial splenic embolizationin patients with portal hypertension in the setting of liver cirrhosis

Abstract

Aim. To improve treatment results in patients with various manifestations of portal hypertension (PH) by simultaneously performing transjugular intrahepatic portosystemic shunt (TIPS) placement and partial splenic embolization.Materials and methods. At the first stage of the study, the incidence of PH manifestations was retrospectively analyzed in 100 consecutive patients with cirrhosis. At the second stage, the safety and efficacy of simultaneously performing TIPS placement and partial splenic embolization were evaluated in a group of 20 patients with esophageal and/or gastric varices and hypersplenism. Control examination was performed at 3, 6, 9, 12, and 15 months after the procedure.Results. Of 100 patients with liver cirrhosis, clinical and instrumental signs of portal hypertension were observed in 86 patients. In 49 (56.9%) patients, portal hypertension was manifested as esophageal and/or gastric varices along with hypersplenism. When TIPS and partial splenic embolization were used together, no in-hospital case fatality and postoperative complications were noted. During a dynamic observation, 2 (10%) fatal outcomes were reported that were not related to variceal bleeding. The severity of varices decreased in 19 (95%) patients while remaining unchanged in 1 (5%) patient. In 5 (25%) patients, encephalopathy was noted to worsen. Six months following the procedure, the platelet count increase reached 109.44 ± 34.26% (54–242), while 12 months later, it amounted to 96.37 ± 23.62% (41–166). After a 6-month follow-up period, an average increase in leukocyte count reached 34.14 ± 24.96% (0–89), amounting to 21.47 ± 18.46% (0–62) after a follow-up period of 12 months.Conclusion. More than half of patients with cirrhosis and portal hypertension suffer from both esophageal and/or gastric varices and hypersplenism. In such patients, it is safe and effective to perform TIPS and partial splenic embolization simultaneously.