Transjugular Intrahepatic Portosystemic Shunt Creation Research Articles

A new alternative technique for the guidance of transjugular intrahepatic portosystemic shunt creation using DSA overlay reference.

Portal vein puncture (PVP) is a critical step during transjugular intrahepatic portosystemic shunt (TIPS) and correlates to several complications. Techniques guiding PVP are needed. To evaluate the safety, feasibility, and efficiency of digital subtraction angiography (DSA) overlay reference during TIPS creation and compare it with transhepatic portal vein (THPV) guiding. The clinical records of 185 patients at three medical centers who underwent TIPS placement were reviewed. Portal vein access was guided by THPV guiding in 120 cases and DSA overlay reference in 60 cases. The number of punctures, portal vein entry time, procedural adverse events, technical and hemodynamic success rate were analyzed to compare the safety, feasibility, and efficiency of the two methods. The median numbers of punctures in group 1 and group 2 were 2 (1-4) and 2 (1-5), respectively (P = 0.094). There was no statistical difference between two groups in needle passes. The median portal vein entry time of group 1 was 12 min (8-16 min) and 13 min (8-16 min) in group 2. No significant difference was found in the PVP time (P = 0.802). Arterioportal fistula formation occurred in 15 patients in group 1; two patients in group 2 had hepatic artery injury. The patients in group 2 had lower rates of procedural adverse events (P = 0.047). Median dose area product of G1 was lower than G2 statistically (P<0.001). There was no significant difference in total fluoroscopy time (P = 0.856). DSA overlay reference has lower procedural adverse events rates compared with THPV guiding TIPS. It seems to be a safe and effective method for guiding PVP.

Percutaneous creation of direct intrahepatic portosystemic shunts \u2013 an alternative for failed TIPS creation

IntroductionDirect intrahepatic portosystemic shunt creation is a feasible and safe alternative for transjugular intrahepatic portosystemic shunt creation. It needs equipment like endovascular ultrasound with restricted availability. We performed the procedure percutaneously with a common interventional armamentarium to make it more feasible.MethodsRetrospective analysis of 8 percutaneous DIPS insertions between 2016 and 2020.ResultsThe procedure was successful in 8/8 patients. There was no short-term death reported within 30 days. The longest reported patency is 5 years.ConclusionPercutaneous DIPS creation is a feasible alternative for failed TIPS. Percutaneously the procedure can be completed faster than conventional DIPS using only minimal puncture equipment.Level of evidenceLevel 4, Case Series.

Clinical Outcomes of Transjugular Intrahepatic Portosystemic Shunt (Tips) Creation Using Fluency Versus Viatorr Stent-Grafts: A Single-Centre Retrospective Study.

To investigate the effects of transjugular intrahepatic portosystemic shunt (TIPS) creation using Fluency versus Viatorr stent-grafts on the long-term clinical outcomes. This was a single-center retrospective study from January 2010 to October 2021 in 213 patients receiving TIPS with Fluency (Fluency group, n = 154) versus Viatorr (Viatorr group, n = 59) stent-grafts. Inclusion criteria were: age > 18years old and TIPS creation for variceal hemorrhage. Exclusion criteria were: age > 80years old, concomitant chronic heart or lung disease, active tuberculosis or human immunodeficiency virus infection, extrahepatic malignancy, alcohol dependence, TIPS created outside of our hospital, without any follow-up data, or decline to participate. The primary outcome was primary patency rate and its associated risk factors. The 5-year cumulative primary patency rate was significantly higher in Viatorr group than in Fluency group (89.0% vs. 19.6%, p < 0.001), whereas the 5-year cumulative transplant-free survival rate (62.3% vs. 62.2%, p = 0.636) was comparable between two groups. Cox-regression models revealed that group (hazard ratio [HR]4.029, 95% confidence interval [CI] 1.486-10.927, p = 0.006), use of bare stents (HR 3.307, 95% CI 1.903-5.747, p < 0.001), and baseline portal vein thrombosis (HR 0.248, 95% CI 0.149-0.412, p < 0.001) were significantly associated with shunt patency. Incidences of adverse events were not significantly different between two groups (p > 0.05). TIPS creation using Viatorr stent-grafts is superior to using Fluency stent-grafts in terms of higher long-term primary patency rate but similar transplant-free survival rate.

Risk of hernia-related complications after transjugular intrahepatic portosystemic shunt creation in patients with pre-existing ventral abdominal hernias: 15-year experience at a quaternary medical center

ObjectiveTransjugular intrahepatic portosystemic shunt (TIPS) placement is used to treat the sequelae of portal hypertension, including refractory variceal bleeding, ascites and hepatic hydrothorax. However, hernia-related complications such as incarceration and...

Transjugular intrahepatic portosystemic shunt for the management of symptomatic malignant pseudocirrhosis

Pseudocirrhosis is defined by radiologic changes of the liver parenchyma secondary to metastatic disease and/or cancer treatments, and portends a high rate of morbidity and mortality from sequelae of portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for portal hypertension; however, TIPS is relatively contraindicated in the setting of hepatic metastases. The study aims to determine the technical efficacy and clinical outcomes of patients undergoing TIPS for symptomatic pseudocirrhosis. Retrospective analysis of patients with hepatic malignancy who underwent TIPS between 2008 and 2020 at a single tertiary care center. Patients with imaging findings of pseudocirrhosis and without history of primary liver malignancy or confounding causes of cirrhosis were included. West Haven scores assessing hepatic encephalopathy were obtained from chart review. Technical success was defined as successful TIPS creation with reduction in the portosystemic gradient (PSG). Clinical success was defined as resolution of variceal bleeding and/or ascites. Nine patients (4 female/5 male), average (± SD) age 61.2±9.5 years with metastatic pseudocirrhosis were included for analysis. Primary malignancy was colorectal adenocarcinoma (n=5), neuroendocrine tumor (n=3), and malignant endothelial hemangioendothelioma (n=1). Average Model for End Stage Liver Disease (MELD-Na) score was 15.7±3.7. Technical success was 8/9 (89%) with average PSG reduced from 23.5±11.0 to 6.5±2.8 mmHg (P=0.001). Clinical success was 6/9 (67%). Two patients required TIPS revision after initial clinical success. Mild-moderate HE occurred in 6/9 patients post TIPS (67%), with a highest West Haven score of 2. Time from TIPS to death for acute variceal bleeding and ascites was 4.9±4.2 and 12±16.5 months, respectively. Cause of death was disease progression (n=5), variceal bleeding (n=1), or unavailable (n=2). TIPS in the setting of malignant pseudocirrhosis can be created safely with similar clinical outcomes to TIPS performed for benign disease. Rates of low-grade hepatic encephalopathy may be higher amongst patients undergoing TIPS for pseudocirrhosis.

Feasibility and clinical effectiveness of transjugular intrahepatic portosystemic shunt creation in pediatric and adolescent patients: a meta-analysis.

Transjugular intrahepatic portosystemic shunt (TIPS) is a useful approach in managing complications caused by severe portal hypertension (PH) in adults. In children, TIPS is technically challenging, and previous studies of TIPS in children have yielded inconsistent results. This study aimed to elucidate the feasibility and clinical effectiveness of TIPS in pediatric and adolescent patients. This meta-analysis study identified relevant publications through medical databases. The primary outcomes included technical success, hemodynamic success, and clinical success. The secondary outcomes were primary patency rate, shunt revision rate, and secondary patency rate. A total of 286 patients representing 13 studies were eligible for analysis. The pooled rates of technical success, hemodynamic success, and clinical success were 95% (95% CI 88-99), 89% (95% CI 81-95), and 93% (95% CI 86-98), respectively. The portosystemic gradient decreased from 21.5mmHg before TIPS to 8.3mmHg after TIPS. The pooled estimates of primary patency rate, shunt revision rate, and secondary patency rate were 84% (95% CI 72-94), 35% (95% CI 21-51), and 100% (95% CI 92-100), respectively. Study results suggest that TIPS may be feasible and effective in children with PH of various etiologies as for long-term management.

Development and Validation of Prognostic Models to Estimate the Risk of Overt Hepatic Encephalopathy After TIPS Creation: A Multicenter Study.

INTRODUCTION:Overt hepatic encephalopathy (HE) is a major complication of transjugular intrahepatic portosystemic shunt (TIPS). This study aimed to develop and validate prognostic models to identify patients at different risks of overt HE within 3 months after TIPS.METHODS:Two cohorts of patients with cirrhosis undergoing TIPS insertion were retrospectively included. In the derivation cohort of 276 patients, 3 models were established in increasing order of complexity: core model (age + Child-Pugh class), sarcopenia model (core model + sarcopenia), and full model (sarcopenia model + post-TIPS portal pressure gradient). All models were internally validated for discrimination and calibration and externally validated in an independent cohort of 182 patients.RESULTS:During a 3-month follow-up period, 61 (22.1%) and 33 patients (18.1%) developed overt HE in the derivation and validation cohort, and sarcopenia was associated with increased risk of the outcome. In the derivation cohort, the core model showed a c-statistic of 0.68 (95% confidence interval [CI] 0.61–0.75), and discrimination improved in the sarcopenia model (c-statistic 0.73; 95% CI 0.66–0.80). The full model that extended the core model with inclusion of sarcopenia and post-TIPS portal pressure gradient showed a significant improvement in discriminative ability (0.77; 95% CI 0.71–0.83; P = 0.001). Both sarcopenia and full model yielded comparable performances in the validation cohort.DISCUSSION:We developed and externally validated 2 prediction models applied before (sarcopenia model) and after TIPS (full model) to estimate the risk of post-TIPS overt HE. These tools could aid to select appropriate candidates for TIPS and guide postoperative management.

Comparison of the Covered Self-Expandable Viatorr CX Stent with the Covered Balloon-Expandable BeGraft Peripheral Stent for Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation: a Single-Centre Retrospective Study in Patients with Variceal Bleeding.

This study compares the safety and efficacy of the ePTFE-covered self-expansible nitinol stent (VIATORR® Controlled Expansion, Gore, Flagstaff, USA) with the ePTFE-covered, balloon-expandable, metallic stent (BeGraft peripheral, Bentley, Hechingen, Germany) for the creation of the transjugular intrahepatic portosystemic shunt (TIPS). From September 2016 to December 2020, 72 consecutive patients receiving TIPS for acute variceal bleeding (rescue and early TIPS, n = 15) or for prophylaxis of variceal rebleeding (n = 57) were enrolled. The main contraindications were patients with vascular liver disease (portal vein thrombosis and Budd-Chiari syndrome). Forty patients (55.6%) received a Viatorr CX stent and 32 patients (44.4%) a BeGraft peripheral stent. Safety endpoints were technical and clinical adverse events and early deaths within 30days after TIPS implantation. Efficacy endpoints were rebleeding rates, recurrence of large varices requiring endoscopic band ligation, or TIPS revision. Groups receiving the Viatorr CX or BeGraft peripheral stent were comparable in all respects except the TIPS indication for acute variceal bleeding (5% vs. 25%, p = 0.015). All patients had a successful intervention, and the physical variables of stent implantation (intervention and fluoroscopy time, reduction of the portosystemic pressure gradient) as well as adjunctive embolization of varices were similar in both groups. Severe clinical complications (Viatorr CX: 5% vs. BeGraft peripheral: 3.1%, p = 0.692), post-TIPS hepatic encephalopathy (12.5% vs. 18.8%, p = 0.743) and death (5% vs. 0%, p = 0.793) were not different between Viatorr CX and BeGraft peripheral groups. With respect to efficacy, freedom from rebleeding and from variceal band ligation during follow-up (100% vs. 100%, p = 1.0), as well as the need for shunt revision (10.5% vs. 18.8%, p = 0.327), was comparable. Compared to the present gold standard, the Viatorr CX stent, the balloon-expandable BeGraft peripheral stent, showed similar results with respect to safety and efficacy.

Sarcopenia of Cirrhosis and the Therapeutic Potential of Transjugular Intrahepatic Portosystemic Shunt Creation

AbstractSarcopenia is a major sequela of cirrhosis, contributing to significant morbidity and mortality. Advances in body composition analysis using medical imaging have begun to identify changes in skeletal muscle and fat that are prognostic of the impact of sarcopenia on medical outcomes in cirrhosis and other pathologies. Recently, observational studies have shown a correlation between transjugular intrahepatic portosystemic shunt (TIPS) creation and a reversal of the progressive muscle loss in cirrhosis. This reversal is also associated with improved clinical outcomes and survival. This review summarizes current understanding of cirrhotic sarcopenia, and discusses the implications of TIPS creation in reversing this process.

Leveraging Value-Based Payment Models to Reduce Health Inequities in Radiology

Leveraging Value-Based Payment Models to Reduce Health Inequities in Radiology

Creation of an Ex-vivo Transjugular Intrahepatic Portosystemic Shunt (TIPS) Training Model Using a Perfused Non-cirrhotic Porcine Liver

Purpose: To validate the feasibility of an ex-vivo flow model with explanted porcine livers for transjugular intrahepatic portosystemic shunt (TIPS) creation using different techniques. Material and Methods: Twenty porcine livers used for other non-related research were explanted after the animals were sacrificed. The inferior vena cava segments and portal vein were connected to vascular grafts. The portal vein graft was connected to a continuous 0.9% sodium chloride solution inflow by fountain pump

Transjugular Intrahepatic Portosystemic Shunt Reduction for Medically Refractory Hepatic Encephalopathy

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is an established intervention for symptomatic portal hypertension. Following TIPS creation, 22-50% of patients experience hepatic encephalopathy (HE), with symptoms ranging from mild confusion to coma. While HE can be medically managed, refractory cases may require downsizing of the TIPS which can be accomplished by deploying a smaller caliber stent within the original shunt. Decreasing shunt diameter redirects blood flow back through liver parenchyma. The purpose of this study was to evaluate the efficacy of TIPS downsizing for the treatment of medically refractory post-TIPS HE.&#x0D; Methods: An IRB-approved, HIPAA compliant retrospective review was performed. A search of an institutional radiology database yielded 45 patients who underwent TIPS downsizing between 2011-2021. Four patients were excluded due to lack of post-TIPS HE, and a total 41 patients were included in the study. Clinical and serologic data were obtained for all 41 patients. The primary objective was to determine the efficacy of TIPS downsizing for reduction of HE as measured by the West Haven criteria. Secondary endpoints included post-downsize recurrence of ascites or gastrointestinal bleeding, procedural complications, and thirty-day mortality.&#x0D; Results: TIPS downsizing was performed in all 41 patients with a 9.8% thirty-day mortality rate. No deaths were attributable to the procedure itself. Of the remaining patients, twenty-seven patients (65.9%) had improvement in HE and 10 patients (24.4%) proceeded to TIPS occlusion due to refractory HE. The average pre-downsize and post-downsize West Haven grades were 2.9 ± 0.5 and 1.9 ± 1.2, respectively. One patient (2.4%) had spontaneous TIPS thrombosis after downsizing and developed gastrointestinal bleeding requiring embolization; 15 patients (36.6%) experienced recurrent ascites.&#x0D; Conclusion: In this population, TIPS downsizing improved medically refractory HE in 65.9% of patients with a 2.4% risk of recurrent gastrointestinal bleeding, 36.6% risk of recurrent ascites, and 9.8% thirty-day mortality.

Portal Vein Thrombosis: Diagnosis and Endovascular Management.

Portal vein thrombosis (PVT) is a rare but severe entity that can cause clinically significant sequela such as worsening portal hypertension or mesenteric ischemia. Those cases refractory to medical management may be referred for endovascular intervention. Several technical considerations have been described in the literature, but a cohesive comparison of these multiple techniques is lacking. The purpose of this article is to review the diagnosis and endovascular management of PVT, including areas in which further research is warranted. Cases of PVT can be readily diagnosed using ultrasound, computed tomography, or magnetic resonance imaging. Treatment often begins with systemic anticoagulation and endovascular interventions may be used in selected cases. Determining the optimal approach to accessing the portal venous system depends on the underlying disease and chronicity of the thrombus and the degree of occlusion. Once access to the portal venous system is established, catheter-directed therapy may be performed to achieve recanalization. Despite the heterogeneity in patient presentation, cases of PVT can be readily diagnosed across several imaging modalities. Strategizing interventional approaches involves evaluation of the underlying disease and the chronicity of the thrombus. · This review will enable interventionalists to establish a framework for treating portal vein thrombosis by identifying patient risk factors and thrombus characteristics that determine patient management.. · The unique risks and benefits for transhepatic, transsplenic, and transmesenteric approaches for establishing portal venous access will be discussed.. · Advantages and complications of thrombolysis, thrombectomy, and transjugular intrahepatic portosystemic shunt creation for treating portal vein thrombosis will be reviewed in detail based on our extensive institutional experience.. · Ju C, Li X, Gadani S et al. Portal Vein Thrombosis: Diagnosis and Endovascular Management. Fortschr Röntgenstr 2022; 194: 169 - 180.

Technical and Medium-Term Clinical Outcomes of Transjugular Intrahepatic Portosystemic Shunt with Fluoroscopy and Additional Trans-abdominal Ultrasound Guidance.

Background and Objective The aim of the study is to evaluate the technical and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) performed with additional transabdominal ultrasound guidance. Material and Methods Patients who underwent TIPS between January 2004 to January 2020 in our center were studied. Technical, hemodynamic, angiographic, and clinical outcome were recorded up to 1 year of follow-up. Results TIPS was attempted in 162 patients (median [range] age 37[3–69] years; 105 were males and 57 were females; Etiology: Budd-Chiari syndrome [BCS] 91, cirrhosis 65, symptomatic acute portal venous thrombosis [PVT] 3, veno-occlusive disease [VOD] 2, congenital portosystemic shunt [CPSS] 1) during the study period. Indication for TIPS was refractory ascites in 135 patients (BCS 86, cirrhosis 49) and variceal bleed in 21 patients (BCS 5, cirrhosis 16). Technical success was seen in 161 of the 162 (99.4%) patients. The tract was created from hepatic vein in 55 patients and inferior vena cava (IVC) in 106 patients. Complications within 1 week post TIPS were seen in 29 of the 162 (18%) patients, of whom one developed unexplained arrhythmia and hypotension and died. Of the patients with available follow-up, clinical success was noted in 120 (81%), while 14 (9%) patients had partial nonresponse and six (4%) had complete nonresponse. Eight (5%) patients died during the follow-up period. Conclusion The technical success of TIPS creation with additional transabdominal ultrasound guidance is very high with low peri-procedural complication rate. It has enabled the inclusion of a wider spectrum of cases like acute PVT and obliterated hepatic veins which were otherwise considered contraindications.

Techniques and Outcomes of Transjugular Intrahepatic Portosystemic Shunting in Infants with Budd-Chiari Syndrome

PurposeTo describe the technical aspects, feasibility, and outcomes in children with Budd-Chiari syndrome (BCS) undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation during infancy. Materials and MethodsA retrospective review of infants with BCS undergoing TIPS creation between January 2012 and December 2018 was performed. Eight infants (5 males) underwent TIPS creation (7 for refractory ascites and 1 for refractory variceal bleeding) during the study period. The median age at TIPS creation was 10.5 months (range, 8–16 months). The median elapsed time between presentation and TIPS creation was 6.5 months (range, 0–13 months). The median weight and median pediatric end-stage liver disease score of the infants at the time of TIPS creation were 6.7 kg (range, 5.4–10 kg) and 13 kg (range, 8–18 kg), respectively. ResultsTIPS creation was successful in all patients. There were no immediate postprocedural complications. An 18-gauge hollow needle was manually curved, through which a 21-gauge Chiba needle was inserted to access the portal vein. All patients received 1 or 2 overlapping bare metal stents. One patient was lost to follow-up after the procedure. The median follow-up duration was 32 months (range, 14–51 months). Four of 7 infants needed reintervention. Two children died during the follow-up period. Two children successfully underwent living donor liver transplant, whereas the remaining 3 children were asymptomatic at the follow-up. ConclusionsTIPS creation was found to be safe and efficacious in improving portal hypertension and growth in these children, although, with a higher rate of reinterventions, possibly due to the use of small, bare metal stents.

Psoas Muscle Density Predicts Occurrences of Hepatic Encephalopathy in Patients Receiving Transjugular Intrahepatic Portosystemic Shunts within 1year.

We aimed to assess the efficacy of psoas density (PD) for predicting hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) procedures. Data were collected from patients who underwent TIPS procedures at a single institution between 2013 and 2019. PD was manually measured using software on unenhanced CT scans at the level of third lumbar vertebra. Laboratory and physical examination data were collected within 24h after admission in order to compare the differences between patients with and without post-TIPS HE. A total of 251 patients were included in this study. Among these patients, 77 (30.7%) developed post-TIPS HE within one year after TIPS creation. The threshold of PD for predicting HE was 51.24 Hounsfield unit (HU). PD values less than this threshold were correlated with an increased risk of HE (hazard ratio 0.92; 95% CI 0.89-0.95, P < 0.001). The area under the receiver operating characteristic curve (AUROC) of PD was 0.743 (95% CI 0.685-0.796), which was superior to Model for End-stage Liver Disease (MELD) (0.569, P = 0.007), albumin-bilirubin score (ALBI) (0.641, P = 0.018), and Child-Pugh score (0.583, P = 0.003). PD measurement showed good HE predictive value in cirrhotic patients who underwent TIPS. This measure also performed better than MELD, ALBI and Child-Pugh.

Use of Cone-Beam Computed Tomography (CBCT) for Targeting the Portal Vein in Transjugular Intrahepatic Portosystemic Shunt (TIPS) Procedures: Comparison of Low-Dose with Standard-Dose CBCT

Background: A transjugular intrahepatic portosystemic shunt (TIPS) is a common treatment for patients with portal hypertension. In these patients, the portal vein can be punctured under the guidance of cone-beam computed tomography (CBCT). Objectives: To compare standard-dose (SD) CBCT with low-dose (LD) CBCT, as three-dimensional (3D) intraprocedural guidance for transhepatic puncture in TIPS placement, in terms of image quality, radiation dose, technical success, and complications. Patients and Methods: A total of 44 patients were retrospectively enrolled in this study. Eighteen patients underwent LD-CBCT, while 26 patients underwent SD-CBCT for guiding the portal vein puncture. A quantitative assessment of image quality was performed by calculating the contrast-to-noise ratio (CNR) of the hepatic portal vein. This analysis was based on a five-point vascular visualization scale (VVS), ranging from optimal (score = 1) to non-diagnostic (score = 5), while a three-point Likert scale was used for motion artifacts (1 = no motion artifacts, 3 = blurred). Image streak artifacts were also rated from one to three, based on the image quality results. Technical success was also investigated, including the number of puncture attempts, time to successful portal vein access, and radiation dose of the TIPS procedure. Results: Based on the results, TIPS could be placed successfully in all cases. Neither VVS (LD-CBCT VVS: 2.78, SD-CBCT VVS: 2.54; P = 0.467), nor the procedure time showed any significant differences between the groups (LD-CBCT: 48.3 min, SD-CBCT: 40.2 min; P = 0.45). Moreover, the objective evaluation of image quality indicated the lower quality of LD-CBCT images; however, the difference was not statistically significant (LD-CBCT CNR: 1.1 ± 0.76, SD-CBCT CNR: 1.3 ± 1.1; P = 0.5). The median number of puncture attempts was the same for SD-CBCT and LD-CBCT (n = 3; range: 1 - 6). Also, the mean dose area product (DAP) was significantly lower in LD-CBCT as compared to SD-CBCT (LD-CBCT: 2733 ± 848 µGm2, SD-CBCT: 6119 ± 1677 µGm2; P &lt; 0.0001). The total DAP was significantly lower using LD-CBCT (LD-CBCT: 14831 ± 9299 µGm2, SD-CBCT: 20985 ± 10127 µGm2; P = 0.047). Conclusion: Both SD-CBCT and LD-CBCT provided successful 3D guidance for portal vein puncture during TIPS creation. Although these methods did not differ significantly in terms of image quality, complications, or number of puncture attempts, LD-CBCT significantly reduced the radiation dose.

Patients' Radiation Shielding in Interventional Radiology Settings: A Systematic Review.

As a result of the increasing risk of developing radiation-related complications, many approaches aimed at reducing this risk and enhancing the outcomes of the patient, doctor or device operator have been developed. In this systematic review, we aim to discuss previous investigations that studied patient shielding or protection within the context of selected interventional radiology procedures. We included original studies that used Ka,r, and PKA for the assessment of the outcomes of two procedures: transjugular intrahepatic portosystemic shunt creation (TIPS) and hepatic arterial chemoembolization (HAE). A thorough search strategy was conducted on relevant databases to identify all relevant studies. We included 13 investigations, including 12 cross-sectional studies and one randomized controlled trial. Significant diversity was found among all these studies in terms of the used modalities, which made them hard to compare. However, almost all studies agreed that using novel imaging and interventional modalities is useful when obtaining better outcomes and reducing patient radiation exposure. The use of ultrasound-guided procedures and providing adequate lead curtains has also been recommended by the identified studies in order to minimize the frequency of radiation exposure. The reported Ka,r, and PKA were also variable between studies and were discussed within this study. Our findings indicate that unified guidelines for patient radiation shielding should be urgently investigated.

Recanalization of Chronic Noncirrhotic, Nonmalignant Splanchnic Thromboses is Feasible: A Transsplenic Assisted Patient-Tailored Approach

The purpose of this study was to evaluate the feasibility of recanalization of chronic noncirrhotic, nonmalignant splanchnic thromboses with a transsplenic assisted patient-tailored approach with or without transjugular intrahepatic portosystemic shunt (TIPS) creation. In this retrospective study, 10 patients (median age, 48.4 years; interquartile range, 5.1 years) underwent revascularization between November 2016 and August 2020. Portal cavernoma was present in all patients, with complete splenic vein thrombosis in 70%. The technical success rate was 80%. Additional TIPS creation was performed in 5 (50%) patients. At a median follow-up of 19.3 months (interquartile range, 17.9 months), the primary and secondary patency rate was 70% and 100%, respectively. During follow-up, 1 patient died due to recurrent upper gastrointestinal variceal hemorrhage. In conclusion, percutaneous transsplenic assisted recanalization of chronic noncirrhotic, nonmalignant splanchnic thromboses is feasible. However, multiple access points may still be needed. Additional TIPS creation appears to be necessary only in case of insufficient portal venous flow into the liver.

Single-Centre Retrospective Training Cohort Using Artificial Intelligence for Prognostic Prediction of Encephalopathy, Mortality, and Liver Dysfunction after Early TIPS Creation.

Based on an artificial intelligence approach, this study attempted to establish prognostic models to predict 3-month overt hepatic encephalopathy (OHE) occurrence, 1-year mortality, and liver dysfunction for cirrhotic patients with acute variceal bleeding (AVB) treated with early transjugular intrahepatic portosystemic shunt (TIPS) creation. This retrospective study included patients treated with early TIPS between January 2016 and November 2019. Independent risk factors associated with occurrence of OHE within 3months, 1-year mortality, and liver dysfunction after early TIPS were identified using univariate and multivariate logistic analyses. Artificial neural network (ANN) models and prognostic nomograms based on the independent risk factors were established and validated internally. A total of 207 patients were included, with 33 (15.9%) experienced OHE within 3months after TIPS creation. The albumin-bilirubin grade (P = 0.015), age (≤ 65, > 65years) (P < 0.001), gender (P = 0.002), and alcoholic cirrhosis (P = 0.013) was identified as independent risk factors associated with 3-month OHE. Presence of portal vein thrombosis (P = 0.034) and model for end-stage liver disease score (P = 0.063) were identified as independent risk factors associated with 1-year mortality. The platelet-albumin-bilirubin grade (P = 0.041) and a history of hepatic encephalopathy (P = 0.018) were identified as independent risk factors associated with liver dysfunction after TIPS creation. Three ANN models and three nomograms were then established and validated with high accuracy. The ANN and nomogram models have potential to accurately predict early occurrence of OHE, mortality, and liver dysfunction after early TIPS creation for cirrhotic patients with AVB.