Portosystemic Shunt For Treatment Research Articles

A Comparative Analysis of the Efficacy of Parallel Stent Versus Conventional Stent Repair in Addressing Dysfunction in Transjugular Intrahepatic Portosystemic Shunt Treatment

A Comparative Analysis of the Efficacy of Parallel Stent Versus Conventional Stent Repair in Addressing Dysfunction in Transjugular Intrahepatic Portosystemic Shunt Treatment

Analysis of the long-term prognosis of transjugular intrahepatic portosystemic shunt treatment for esophagogastric variceal hemorrhage concomitant with sarcopenia in cirrhotic patients

Objective: To explore whether transjugular intrahepatic portosystemic shunt (TIPS) can improve the prognosis of esophagogastric variceal bleeding (EGVB) combined with sarcopenia in cirrhotic patients. Methods: A retrospective cohort study was performed. A total of 464 cases with cirrhotic EGVB who received standard or TIPS treatment between January 2017 and December 2019 were selected. Regular follow-up was performed for the long-term after treatment. The primary outcome was transplantation-free survival. The secondary endpoints were rebleeding and overt hepatic encephalopathy (OHE). The obtained data were statistically analyzed. The t-test and Wilcoxon rank-sum test were used to compare continuous variables between groups. The χ2 test, or Fisher's exact probability test, was used to compare categorical variables between groups. Results: The age of the included patients was 55.27±13.86 years, and 286 cases were male. There were 203 cases of combined sarcopenia and 261 cases of non-combined sarcopenia. The median follow-up period was 43 months. The two groups had no statistically significant difference in follow-up time. There was no statistically significant difference in transplant-free survival between the TIPS group and the standard treatment group in the overall cohort (HR=1.31, 95%CI: 0.97-1.78, P=0.08). The TIPS patient group with cirrhosis combined with sarcopenia had longer transplant-free survival (median survival: 47.76 vs. 52.45, χ2=4.09; HR=1.55, 95CI: 1.01~2.38, P=0.04). There was no statistically significant difference in transplant-free survival between the two kinds of treatments for patients without sarcopenia (HR=1.22, 95%CI: 0.78~1.88, P=0.39). Rebleeding time was prolonged in TIPS patients with or without sarcopenia combination (patients without combined sarcopenia: median rebleeding time: 39.48 vs. 53.61, χ2=18.68; R=2.47, 95CI: 1.67~3.65, P<0.01; patients with sarcopenia: median rebleeding time: 39.91 vs. 50.68, χ2=12.36; HR=2.20, 95CI: 1.42~3.40, P<0.01). TIPS patients had an increased 1-year OHE incidence rate compared to the standard treatment group (sarcopenia patients: 6.93% vs. 16.67%, χ2=3.87, P=0.049; patients without sarcopenia combination: 2.19% vs. 9.68%, χ2=8.85, P=0.01). There was no statistically significant difference in the long-term OHE incidence rate between the two kinds of treatment groups (P>0.05). Conclusion: TIPS can significantly prolong transplant-free survival compared to standard treatment as a secondary prevention of EGVB concomitant with sarcopenia in patients with cirrhosis. However, its advantage is not prominent for patients with cirrhosis in EGVB without sarcopenia.

Successful Transjugular Portosystemic Shunt Treatment of Pediatric Sinusoidal Obstruction: Case Report and Review of Literature.

In adults with medically refractory sinusoidal obstruction syndrome (SOS), a transjugular intrahepatic portosystemic shunt (TIPS) has been used successfully to improve portal hypertension and symptoms such as ascites. There is limited data on the use of TIPS for SOS in pediatric patients. The index case was reviewed retrospectively. PubMed and Medline databases were searched to identify other cases. A 4-year-old male with high-risk neuroblastoma, developed SOS after tandem autologous stem cell transplant. He was medically managed with defibrotide, diuretics, and peritoneal drainage, but, due to refractoriness, he underwent TIPS day +54 following bone marrow transplant. Hepatic venous pressure gradient improved from 17 to 8 mm Hg following TIPS placement with significant improvement in the patient's clinical status and ascites. However, 15 months later, his shunt remained patent, and he remains clinically well with stable liver enzymes. A literature review identified 13 pediatric cases of TIPS for SOS due to varied causes. TIPS caused a median hepatic venous pressure gradient of 9 mmHg (range, 2-38 mm Hg). The mortality following the procedure was 15%, with 2 cases who died at 2- and 11-days post-TIPS. At the time of the last follow-up (range 8-25 months), 5 patients were alive, and 8 were lost to follow-up. We present here a pediatric case of SOS due to stem cell transplant treated successfully with TIPS with a review of the literature. A timely, individualized application of TIPS can be effective in treating children with medication-refractory SOS.

Application of transmesenteric vein extrahepatic portosystemic shunt in treatment of symptomatic portal hypertension with cavernous transformation of portal vein

PurposeTo evaluate the feasibility and efficacy of a transmesenteric vein extrahepatic portosystemic shunt (TmEPS) for the treatment of cavernous transformation of the portal vein (CTPV). Materials and methodsThe clinical data of 20 patients with CTPV who underwent TmEPS between December 2020 and January 2022 ​at Henan Provincial People's Hospital were retrospectively collected. The superior mesenteric vein (SMV) trunk was patent or partially occluded in these patients. An extrahepatic portosystemic shunt between the inferior vena cava and the SMV was established using a stent graft through an infraumbilical median longitudinal mini-laparotomy. The technical success, efficacy, and complication rates were evaluated, and the pre- and postoperative SMV pressures were compared. Patients' clinical outcomes and shunt patency were assessed. ResultsTmEPS was successfully performed in 20 patients. The initial puncture success rate of the balloon-assisted puncture technique is 95%. The mean SMV pressure decreased from 29.1 ​± ​2.9 ​mmHg to 15.6 ​± ​3.3 ​mmHg (p ​< ​0.001). All symptoms of portal hypertension resolved. No fatal procedural complications occurred. During the follow-up period, hepatic encephalopathy occurred in two patients. The remaining patients remained asymptomatic. All shunts were patent. ConclusionsTmEPS is a feasible, safe, and effective treatment option for patients with CTPV.

S3336 An Unusual Cause of Encephalopathy

Introduction: Hepatic encephalopathy, while common among cirrhosis patients, can occur without cirrhosis. In adults, 90% cases of hyperammonemia are due to cirrhosis. Ammonia is central to its pathophysiology produced by bacterial degradation in the gut from protein, urea, and glutamine. Ammonia acts as a neurotoxin which is metabolized by hepatocytes to urea for excretion via kidney and colon. Type B hepatic encephalopathy is due to portosystemic shunting without parenchymal liver disease. Case Description/Methods: A 69-year-old female with history of hepatoma with resection and chemoembolization in 1997, mucosa-associated lymphoid tissue, perforated diverticulitis status post colostomy and reversal in 2015 was in her usual state of health a day prior to admission when she presented with lethargy after episodes of nausea and vomiting. She was arousable and not able to follow commands. Her CT (computed tomography) of the brain with no acute changes followed by CT of abdomen showing dilated small intestine extending into ventral hernia with concern for obstruction. Blood tests revealed ammonia 141 umol/L, total bilirubin 4.1 mg/dL, direct bilirubin 1.5 mg/dL, international normalized ratio 1.2 and platelet 130 k/ul. Alkaline phosphatase, alanine and aspartate transaminases were within normal limits. Obstruction resolved with conservative management and she was started on rectal and oral lactulose with rifaximin via nasogastric tube. Her mentation improved significantly although the cause of her hepatic encephalopathy remained unclear. Then she underwent magnetic resonance imaging of the abdomen with contrast showing portal to hepatic vein shunt with stable postoperative changes. Shunt closure option was discussed and patient opted outpatient follow up. Discussion: Prompt diagnosis and treatment of hepatic encephalopathy is important to prevent cerebral edema. In patients with encephalopathy and elevated ammonia in absence of liver parenchymal disease, work-up for shunt and urea cycle enzyme deficiency should be done. In the absence of cirrhosis most portosystemic shunts are congenital or traumatic. This case brings a rare cause due to remote liver surgery and chemoembolization. The treatment of portosystemic shunts is evolving, balloon-occlusion retrograde transvenous obliteration is one such technique. In the absence of varices, bland embolization with ectopic coils and vascular plugs can be utilized. Endovascular treatment carries an improvement of hepatic encephalopathy by 50 to 80% at 18 to 24 months.

S2700 Transjugular Intrahepatic Portosystemic Shunt for Treatment of Recurrent Isolated Chylothorax Caused by Cirrhosis

S2700 Transjugular Intrahepatic Portosystemic Shunt for Treatment of Recurrent Isolated Chylothorax Caused by Cirrhosis

Effects of transjugular intrahepatic portosystemic shunt treatment of patients with liver cirrhosis and portal hypertension: Case series.

Effects of transjugular intrahepatic portosystemic shunt treatment of patients with liver cirrhosis and portal hypertension: Case series.

Effects of transjugular intrahepatic portosystemic shunt treatment of patients with liver cirrhosis and portal hypertension: Case series: Erratum.

Effects of transjugular intrahepatic portosystemic shunt treatment of patients with liver cirrhosis and portal hypertension: Case series: Erratum.

Effects of transjugular intrahepatic portosystemic shunt treatment of patients with liver cirrhosis and portal hypertension: Case series.

Rationale:Transjugular intrahepatic portosystemic shunt (TIPS) is well established as an effective treatment tool for portal hypertension. However, the effects of TIPS in patients with liver cirrhosis and portal hypertension have not been adequately verified in clinical trials.Patient Concerns:To evaluate the effects of TIPS in patients with liver cirrhosis and portal hypertension with or without portal vein thrombosis (PVT).Interventions:A total of 55 patients with liver cirrhosis and portal hypertension received TIPS treatment from December 2014 to April 2018 were enrolled. Clinical data, including portal pressure, Child-Pugh score, and relevant complications were recorded.Outcomes:TIPS was successfully performed in 54 patients. The overall technical success rate was 98.19% without serious technical complications. After TIPS treatment, portal pressure was significantly reduced from 38.13 ± 4.00 cmH2O to 24.14 ± 3.84 cmH2O (P < 0.05). In addition, symptoms including gastrointestinal bleeding and ascites were improved after TIPS treatment. During the 6 to 21-month follow up, hepatic encephalopathy in 15 patients (27.8%), shunt dysfunction in 5 patients (9.3%), rebleeding in 12 patients (22.2%) and deterioration of liver function in 2 patients (3.7%) were recorded. Moreover, there were no significant differences in the rates of rebleeding and hepatic encephalopathy between patients with PVT and the non-PVT group, whereas the occurrence rate of TIPS dysfunction was higher in the PVT group, but not statistically significant.Lessons:TIPS treatment could alleviate the symptoms of liver cirrhosis and portal hypertension in individuals with or without PVT. However, complications during follow-up should be appropriately noted and addressed with corresponding treatments.

Prediction of overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt treatment: a cohort study

Background/purposeOvert hepatic encephalopathy (HE) risk should be preoperatively predicted to identify patients suitable for curative transjugular intrahepatic portosystemic shunt (TIPS) instead of palliative treatments.MethodsA total of 185 patients who underwent TIPS procedure were randomised (130 in the training dataset and 55 in the validation dataset). Clinical factors and imaging characteristics were assessed. Three different models were established by logistic regression analyses based on clinical factors (ModelC), imaging characteristics (ModelI), and a combination of both (ModelCI). Their discrimination, calibration, and decision curves were compared, to identify the best model. Subgroup analysis was performed for the best model.ResultsModelCI, which contained two clinical factors and two imaging characteristics, was identified as the best model. The areas under the curve of ModelC, ModelI, and ModelCI were 0.870, 0.963, and 0.978 for the training dataset and 0.831, 0.971, and 0.969 for the validation dataset. The combined model outperformed the clinical and imaging models in terms of calibration and decision curves. The performance of ModelCI was not influenced by total bilirubin, Child–Pugh stages, model of end-stage liver disease score, or ammonia. The subgroup with a risk score ≥ 0.88 exhibited a higher proportion of overt HE (training dataset: 13.3% vs. 97.4%, p < 0.001; validation dataset: 0.0% vs. 87.5%, p < 0.001).ConclusionOur combination model can successfully predict the risk of overt HE post-TIPS. For the low-risk subgroup, TIPS can be performed safely; however, for the high-risk subgroup, it should be considered more carefully.Graphic abstract

Computed tomography-based score model/nomogram for predicting technical and midterm outcomes in transjugular intrahepatic portosystemic shunt treatment for symptomatic portal cavernoma.

Transjugular intrahepatic portosystemic shunt (TIPS) may be technically difficult in patients with cavernous transformation of the portal vein (CTPV). Computed tomography (CT) is widely used for assessing the situation of the portal vein and its tributaries before TIPS, and an ultrasound-based Yerdel grading system has been developed, which is deemed useful for liver transplantation. Therefore, we hypothesized that a CT-based CTPV scoring system could be useful for predicting technical and midterm outcomes in TIPS treatment for symptomatic portal cavernoma. To investigate the clinical significance of a CT-based score model/nomogram for predicting technical success and midterm outcome in TIPS treatment for symptomatic CTPV. Patients with symptomatic CTPV who had undergone TIPS from January 2010 to June 2017 were retrospectively analysed. The CTPV was graded with a score of 1-4 based on contrast-CT imaging findings of the diseased vessel. Outcome measures were technical success rate, stent patency rate, and midterm survival. Cohen's kappa statistic, the Kaplan-Meier and log-rank tests, and uni- and multivariable analyses were performed. A nomogram was constructed and verified by calibration and decision curve analysis. A total of 76 patients (45 men and 31 women; mean age, 52.3 ± 14.7 years) were enrolled in the study. The inter-reader agreement (κ) of the CTPV score was 0.81. TIPS was successfully placed in 78% of patients (59/76). The independent predictor of technical success was CTPV score (odds ratio [OR] = 5.56, 95% confidence interval [CI]: 3.55-9.67, P = 0.002). The independent predictors of primary TIPS patency were CTPV score and splenectomy (OR = 9.22, 95%CI: 4.78-13.45, P = 0.009; OR = 4.67, 95%CI: 2.59-7.44, P = 0.017). The survival rates differed significantly between the TIPS success and failure groups. The clinical nomogram was made up of patient age, model for end-stage liver disease score, and CTPV score. The calibration curves and decision curve analysis verified the usefulness of the CTPV score-based nomogram for clinical practice. TIPS should be considered a safe and feasible therapy for patients with symptomatic CTPV. Furthermore, the CT-based score model/nomogram might aid interventional radiologists in therapeutic decision-making.

3:00 PM Abstract No. 247 A simple computed tomography–based score model/nomogram for predicting technical success and midterm outcome in transjugular intrahepatic portosystemic shunt treatment for symptomatic portal cavernoma

3:00 PM Abstract No. 247 A simple computed tomography–based score model/nomogram for predicting technical success and midterm outcome in transjugular intrahepatic portosystemic shunt treatment for symptomatic portal cavernoma

Efficacy of transjugular intrahepatic portosystemic shunt in treatment of sinusoidal obstruction syndrome caused by gynura segetum

Objective To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of sinusoidal obstruction syndrome (SOS) caused by gynura segetum. Methods The clinical data of 9 patients with SOS caused by gynura segetum (5 males and 4 females) who underwent TIPS were retrospectively analyzed from February 2017 to June 2018. The Child-Pugh scores were (9.5±1.3) and the MELD scores were (12.5±5.0). The success rates, complications and follow-up results were evaluated. Results TIPS was performed successfully in all the 9 patients. The portal venous pressure gradient dropped from (22.4±2.7) mmHg to (10.4±3.2) mmHg (P<0.05). There was no complication such as abdominal hemorrhage and biliary peritonitis. Nine patients were followed-up for 1~17months, mean 7.8±6.0 months. One month after treatment, the Child-Pugh scores were (7.1±1.8), compared with that of the preoperative scores, the difference was statistically significant (P<0.05). The MELD scores were (5.3±4.6), compared with that of the preoperative scores, the difference was also statistically significant (P<0.05). At the end point of the follow-up, color Doppler ultrasound and portal CTA showed that the TIPS shunt was patent and hepatic congestion was relieved in all the 9 patients. All patients were alive. Conclusion TIPS was a safe and efficacious treatment for SOS caused by gynura segetum. Key words: Portasystemic shunt, transjugular intrahepatic; Gynura segetum; Sinusoidal obstruction syndrome

Model for end-stage liver disease score and hemodynamic instability as a predictor of poor outcome in early transjugular intrahepatic portosystemic shunt treatment for acute variceal hemorrhage.

To evaluate the outcome of early transjugular portosystemic shunt (TIPS) treatment in patients with a trial-compatible high-risk variceal bleeding and secondly to disclose other predictors of early mortality. A cohort study was conducted on patients referred for a TIPS procedure with or without combined variceal embolization to control acute esophageal variceal bleeding. A total of 32 patients with Child-Pugh C score less than 14 or Child-Pugh B plus active bleeding at endoscopy, admitted for early-TIPS treatment (<72 h), were included. We noted one (3.7%) failure to control bleeding and no rebleeding during 1-year follow-up. Ten (31.3%) patients died within 6 weeks after TIPS placement. Early mortality was associated with model for end-stage liver disease (MELD) score (P=0.025), MELD score of at least 19 (P=0.008) and hemodynamic instability at time of admission (P=0.001). If hemodynamic instability is associated with a high MELD score, the 6-week mortality peaks at 77.8% (P=0.000). This study confirms the excellent survival results of early-TIPS treatment for acute variceal bleeding in a selected patient group with a low MELD score. Poor survival in hemodynamically unstable patients with high MELD scores (≥19) contests the guidelines that patients with Child-Pugh class C cirrhosis or Child-Pugh class B with active bleeding on endoscopy should deliberately receive preemptive TIPS treatment after endoscopic haemostasis.

Long-term clinical outcomes in patients with viral hepatitis related liver cirrhosis after transjugular intrahepatic portosystemic shunt treatment

BackgroundTransjugular intrahepatic portosystemic shunt (TIPS) procedure has played a vital role in management of portal hypertension. Thus, we aimed to investigate the natural history, long-term clinical outcome, predictors of survival in viral hepatitis related cirrhotic patients post-TIPS.MethodA total of 704 patients with complete followed-up data were enrolled, and clinical characteristics of patients were collected and analyzed. Kaplan-Meier method was used to calculate survival, and comparisons were made by log rank test. A multivariate analysis of factors influencing survival was carried out using the Cox proportional hazards regression model.ResultsTIPS implatantion significantly decreased portal vein pressure with 9.77 cmH2O reduction, without influencing long-term liver functions. The total incidence rate of major complication post-TIPS, including HE and re-bleeding/bleeding, was 37.9% and 15.5%, respectively. Patients in Child-Pugh C stage revealed higher overt hepatic encephalopathy (HE) occurrence (65.6%), while patients receiving covered, 6 mm in diameter stents indicated notably lower incidence of HE in comparison with other groups (6.4%). The median survival was > 60 months, 27.0 months, and 11.5 months in cirrhotic patients with variceal bleeding, refractory ascites, and both complications, respectively. The cumulative 5-year survival was significantly higher in patients with variceal bleeding (75.6%) in comparison with either that in patients with refractory ascites (12.5%) or that in patients with both complications (1.96%) (P < 0.0001). Covered stents usage, baseline model for end-stage liver disease (MELD) score, and baseline Child-Pugh classification were predictive of survival (P < 0.001). Other variables including age, male gender, and pre-TIPS PVP were not emerged as significant predictors (P > 0.05).ConclusionTIPS was an effective and safe therapeutic method for decompression of portal hypertension and for treatment of its complications. Careful selection of patients with minimal liver dysfunction for TIPS implantation was essential for better long-term outcomes.

Transjugular intrahepatic portosystemic shunt treatment of variceal bleeding in an unselected patient population

Objective: To evaluate transjugular intrahepatic portosystemic shunt (TIPS) in variceal bleeding in a clinical setting.Materials and methods: Retrospective review of 131 patients (116 with liver cirrhosis) treated with TIPS with covered stent grafts in a single centre from 2002 to 2016.Results: Survival at 1 and 2 years was 70% and 57% in patents with, and 100% at 2 years in patients without liver cirrhosis, respectively. A high Child–Pugh score and severe hepatic encephalopathy (HE) within 12 months post-TIPS were related to increased mortality. Re-bleeding occurred in 8% within 12 months and was related to TIPS dysfunction and a post-TIPS portosystemic gradient (PSG) of ≥5 mmHg. The main cause of TIPS dysfunction was that the stent did not fully reach the inferior vena cava. There was no correlation between the PSG and the occurrence of HE.Conclusions: TIPS was safe and prevented re-bleeding in patients with variceal bleeding, with or without liver cirrhosis, regardless of Child–Pugh class and of how soon after bleeding onset, the TIPS procedure was performed. A post-TIPS PSG of ≥5 mmHg was associated with an increased risk for re-bleeding and there was no correlation between the post-TIPS PSG and the occurrence of HE.

Percutaneous transhepatic intrahepatic portosystemic shunt for treatment of portal hypertension due to chronic portal vein occlusion after splenectomy

Objective To study the feasibility and efficacy of percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS) in patients with portal hypertension due to chronic portal vein occlusion after splenectomy. Methods 27 patients who had portal hypertension due to chronic portal vein occlusion after splenectomy underwent PTIPS between December 2010 and March 2015. These patients were enrolled in this retrospective study. The success rates, efficacy, and complications were evaluated. Significance in the differences in the portosystemic pressure gradient (PPG) as measured before and after PTIPS procedure was assessed. Results PTIPS was successfully carried out in 25 patients but failed in 2. No fatal procedural complications were observed. The mean PPG dropped from (22.3±5.7) mmHg to (12.4±3.1) mmHg after successful PTIPS (1 mmHg=0.133 kPa, P<0.05). The median follow-up in the 25 patients with successful PTIPS were 22 months and there were 3 (12.0%) deaths from liver failure due to severe cirrhosis, and 1 death (4.0%) from stroke during the follow-up period. Shunt dysfunction happened in 4 (16.0%) patients. The original symptoms reoccurred in 2 patients (8.0%) and the remaining patients were diagnosed by routine CT or US examination. Three patients recovered after shunt revision with stent implantation or balloon angioplasty, while one patient refused any further therapy except oral medication. This patient suffered from the first episode of rebleeding 36 months after PTIPS. Hepatic encephalopathy developed in 2 (8.0%) patients, 1 patient recovered after medical treatment, while the other who developed Grade 3 hepatic encephalopathy recovered after implanting a smaller cover stent. The remaining patients were asymptomatic with patent shunts. Conclusion PTIPS was a feasible, safe, and efficacious treatment for portal hypertension due to chronic portal vein occlusion after splenectomy. Key words: Venous thrombosis; Portal vein, hypertension; Splenectomy; Portosystemic shunt

Radiology-guided Occlusion of Portosystemic Shunts for Treatment of Medically Refractory Hepatic Encephalopathy

Radiology-guided Occlusion of Portosystemic Shunts for Treatment of Medically Refractory Hepatic Encephalopathy

Clinical study on transjugular intrahepatic portosystemic shunt in treatment of portal hypertension of patients with hepatocellular carcinoma

Objective To evaluate the therapeutic efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of portal hypertension of patients with hepatocellular carcinoma.Methods Ninety-five portal hypertension patients with hepatic carcinoma were enrolled.TIPS was performed in 63 patients and the other 32 patients received support medical care.The data referred to survival time of the 95 patients after treatment was collected by follow-up visit.The informations about success rate of TIPS,hepatic encephalopathy,rebleeding and causes of death were assessed.The Kaplan-Meier method was used to compare the survival time between two groups.The association of survival time with Child-Pugh classification and model for end-stage liver disease (MELD) score was analyzed.Results The success rate of TIPS was 97.8% with reduction of mean portal vein pressure of 13.6 cmH2O(1 cmH2O=0.098 kPa).The incidence of hepatic encephalopathy was 20.6% and rebleeding was 26.3% six months after TIPS treatment.Fifty-six patients treated with TIPS died at the end of follow-up.Twelve of which were died of variceal bleeding complicated with portal hypertension.The median survival time of TIPS group (3.67 months) was significantly longer than that of control group (1 month). Moreover, the median survival time in patients with low MELD score (≤13) was significantly longer than that in those with high MELD seore (＞13, x2=4.71,P=0.03). Whereas the median survival time was decreasing from Child-Pugh A to C(x2=15.6,P=0.00). Conclusions TIPS is one of effective and safe therapeutic methods to control portal hypertension. However, liver function is an important factor for selcetion of TIPS. Key words: Carcinoma,hepatocellular; Hypertension,Portal; Portosystemie shunt,Transjugular intrahepatic

Severe ascites: efficacy of the transjugular intrahepatic portosystemic shunt in treatment.

To evaluate the transjugular intrahepatic portosystemic shunt (TIPS) as primary treatment in patients with cirrhosis and severe ascites. A TIPS placement was attempted in 54 consecutive patients with intractable ascites. Clinical assessment findings, shunt patency, complications, and survival were analyzed. A TIPS was successfully placed in 50 patients (93%). Follow-up for clinical effectiveness in 51 patients was a mean of 285 days (range, 1-981 days). Forty patients (78%) gained clinical benefit from the shunt. Of these, 29 (57%) had a complete response (required no further paracentesis) and 11 patients (22%) had a partial response (required less frequent but additional paracentesis for control of ascites). The absence of preprocedure renal insufficiency (creatinine < 1.5 mg/dL [< 130 mumol/L]) was the only characteristic identified as an indicator of clinical success (P < .05). Eleven patients (22%) required shunt revision during follow-up to gain or prolong control of symptoms. Cumulative survival in the population evaluated for clinical efficacy was 53% at 6 months and 48% at 1 year. A complete response was the only variable that indicated increased survival (P < .05; R2 = 12%) with a 6-month survival rate of 76% and a 1-year rate of 71%. TIPS placement appears to be effective as a primary treatment of patients with cirrhosis and severe ascites.