Results of transjugular intrahepatic portosystemic shunt combined with selective gastric vein embolization

Abstract

Aim. To improve the outcomes of surgical treatment of patients with cirrhosis complicated by clinically significant portal hypertension by performing TIPS with selective embolization of gastric veins.Materials and methods. The authors explored the immediate and long-term outcomes of treatment of 62 patients with liver cirrhosis: group I included 27 patients who underwent TIPS with selective embolization of one left gastric vein; group II included 35 patients who underwent TIPS with selective embolization of ≥2 gastric veins. The authors tested a non-invasive method for predicting the risk of bleeding from gastric and oesophageal varices after TIPS with selective embolization of gastric veins and compared MRI and EGD results before and after the surgery (n = 14).Results. The maximum follow-up duration comprised 72 months. Bleeding from the oesophageal veins was not reported in the early period after TIPS with embolization of the left gastric vein, however, the long-term bleeding developed in 2 patients (7.4%). In 6–72 months following TIPS with embolization of the left gastric vein and posterior gastric vein, as well as short gastric veins (when indicated), no recurrences of variceal bleeding appeared. The method of predicting the risk of bleeding after TIPS proved to be effective in all 14 patients in the follow-up period of 6 months (invention application No. 2022129022).Conclusion. The obtained results confirmed the efficacy of TIPS combined with gastric vein embolization. The unique patent solution determined the technique, indications and peculiarities of the intervention.