Abstract
Purpose To evaluate the effect of puncture sites of the portal vein in transjugular intrahepatic portosystemic shunt (TIPS) on long-term clinical efficacy. Methods A retrospective review was performed, including consecutive 171 patients who underwent TIPS with ePTFE-covered stents. All patients were divided into 3 groups according to the puncture site of the portal vein: intrahepatic bifurcation of the portal vein (group A, n = 88), right branch of the portal vein (group B, n = 48), and left branch of the portal vein (group C, n = 35). The Kaplan-Meier analysis was performed to assess the effect of different puncture sites on primary patency, the incidence of hepatic encephalopathy (HE), and survival. Results The primary restenosis rate was 29.8% (51/171). The total HE rate was 31.6% (54/171). The cumulative death rate was 19.3% (33/171). The Kaplan-Meier analysis showed that group C versus group A, group C versus group B, and group A versus group B were significantly different on the primary restenosis rate, respectively (χ2 = 11.49, P = 0.001; χ2 = 4.54, P = 0.033; and χ2 = 4.12, P = 0.046), and group C is better than the other two groups. What is more, group C versus group A and group C versus group B were significantly different on the incidence of HE, respectively (χ2 = 8.07, P = 0.004; χ2 = 9.44, P = 0.002), and group C is better than the other two groups. There was no significant difference on survival. Conclusion Choosing the left branch of the portal vein as the puncture site to create the shunt in TIPS with ePTFE-covered stents may decrease the incident of primary restenosis and HE significantly.
Highlights
Transjugular intrahepatic portosystemic shunts (TIPS) has evolved into an effective and durable nonsurgical option in the treatment of portal vein hypertension [1,2,3,4]
From anatomical reason and technical difficulty, most TIPS are performed by selecting the right branch or intrahepatic bifurcation of the portal vein, as they are easy to be punctured from the hepatic vein
Our study aims at evaluating the Gastroenterology Research and Practice effect of puncture sites of the portal vein in TIPS on longterm clinical efficacy
Summary
Transjugular intrahepatic portosystemic shunts (TIPS) has evolved into an effective and durable nonsurgical option in the treatment of portal vein hypertension [1,2,3,4]. From anatomical reason and technical difficulty, most TIPS are performed by selecting the right branch or intrahepatic bifurcation of the portal vein, as they are easy to be punctured from the hepatic vein. Some tended to agree that there was no necessity to choose the puncture site deliberately if the compliance of shunts was satisfactory, while some believed that patients with the optimal stent position could acquire better long-term clinical efficacy. Our study aims at evaluating the Gastroenterology Research and Practice effect of puncture sites of the portal vein in TIPS on longterm clinical efficacy
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