To assess technical predictors of Transjugular Intrahepatic Portosystemic Shunt (TIPS) dysfunction. Materials: A retrospective cohort analysis of 235 consecutive patients that underwent TIPS placement from Jan 2014-Feb 2017 was analyzed. Technical factors assessed included TIPS location (proximal and distal landing zone), operator experience, portal vein thrombosis, TIPS angle acuity, and stent length. TIPS angle was defined as the angle of stent entry into the portal vein and was measured by two independent radiologists blinded from the analysis. Proximal landing zone was defined by shunt origin in the inferior vena cava (IVC), right hepatic vein (RHV), middle hepatic vein (MHV), or left hepatic vein (LHV). Distal landing zone was categorized as right, left, or main portal vein (RPV, LPV, MPV). A multiple logistic regression model was used for analysis. Results: Of 235 patients who had initial TIPS placement, 17.4% (41/235) underwent subsequent revision for TIPS dysfunction. TIPS dysfunction was due to stenosis at the hepatic venous end (24/41), mid-portion of the stent (2/41), portal venous end (6/41), complete thrombosis (6/41), and multifactorial in (3/41). Median follow-up was 27.1 mo. Average time after TIPS placement to TIPS dysfunction was 5.7 ± 5.0 mo. TIPS was most commonly placed in RHV extending to RPV (68.5%, 161/235), followed by MHV to RPV (11.9%, 28/235), with the rest originating in MHV or IVC and ending in MPV or LPV (19.5%, 46/235). Decreasing angle of entry into the portal vein was associated with greater likelihood of TIPS dysfunction (OR 0.926, 95%CI .904-.949, p<.001). Average TIPS angle for patients with TIPS dysfunction was 111.8 ± 19.1 compared to 136.5 ± 15.6 in those without dysfunction (p<.001). Stent length (p ¼ .304), operator experience (p ¼ .344), portal vein thrombosis (p ¼ .388), proximal TIPS landing zone (p ¼ .324), and distal TIPS landing zone (p ¼ .167) were not predictors of TIPS dysfunction. Conclusions: The angle of TIPS stent entry into the portal vein is a predictor of future TIPS dysfunction. Stent length, shunt location, operator experience, and portal vein thrombosis were not associated with TIPS dysfunction.
Objective This study aimed to investigate pregnancy rate, pregnancy outcomes, and resumption of menses after transcatheter arterial embolization (TAE) for obstetric hemorrhage (OH). Study Design Sixty-seven patients who underwent TAE for OH from 2006 to 2020 within an urban, multihospital health care system were identified retrospectively. Selected patients were interviewed by phone to complete a survey with a primary outcome of self-reported pregnancy in those seeking pregnancy. Secondary outcomes included pregnancy outcomes and resumption of menses. Univariate testing of association of pregnancy and miscarriage rate with embolic agent was performed using Fisher's exact test. Results Thirty-three of 50 patients (66%) meeting the inclusion criteria completed the survey on fertility, a median of 47 (range, 13–123) months after TAE for OH. Of the 13 patients who attempted pregnancy, there was a pregnancy rate of 77% and miscarriage rate of 38%. Those who delivered live newborns conceived spontaneously, carried to term, and delivered a healthy newborn via cesarean section at a weight appropriate for gestational age. Thirty (91%) patients resumed menstruation, and the majority with unchanged frequency. Most patients underwent bilateral uterine artery embolization with radial artery access (54%). The most common embolic agents used were gelfoam only (30%) and glue only (24%). There was no statistically significant association between embolic agent and pregnancy or miscarriage rate. Conclusion Spontaneous pregnancy with live birth and resumption of menses can occur in a majority of patients after TAE for OH. Key Points
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