Transjugular Intrahepatic Portosystemic Shunt:The Impact of Portal Venous Pressure Declines on Shunt Patency and Clinical Efficacy

Wan, Yue-Meng; Li, Yuhua; Wu, Hua‐Mei; Wu, Xinan; Xu, Ying; Guo, Tao

doi:10.1016/j.acra.2018.05.015

Cited by 11 publications

(12 citation statements)

References 31 publications

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“…TIPS insertion was conducted as previously described in detail [ 12 13 ]. At the discretion of operating interventional radiologists, all TIPS procedures were conducted using ePTFE-covered legacy Viatorr TIPS stent-grafts (VTS; Viatorr®, W.L.…”

Section: Methodsmentioning

confidence: 99%

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Elective Transjugular Intrahepatic Portosystemic Shunt Using Viatorr Stent-Grafts: A Single-Center Experience from China

Wan

et al. 2022

Journal of the Belgian Society of Radiology

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Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established approach for the management of variceal bleeding, refractory ascites, hepatic hydrothorax, and preoperative treatment of portal hypertension prior to major abdominal surgery in patients with compensated cirrhosis, and so on. This study aimed to investigate the safety and long-term efficacy of TIPS implantation using Viatorr TIPS stent-grafts. Material and Methods: A cohort of 59 patients undergoing TIPS placement using Viatorr TIPS stent-grafts were included, and the periprocedural events, and long-term mortality, shunt dysfunction, variceal rebleeding and incidence of hepatic encephalopathy (HE) were analyzed. Results: The technical success rate was 100%. The median portosystemic pressure gradient was reduced from 21 mmHg (interquatile range: 19–25) to 13 mmHg (interquatile range: 10–16) before and after TIPS, leading to a hemodynamic success rate of 72.9%. The cumulative rate of overall mortality was 34.2% at five years, and direct bilirubin (hazard ratio [HR] = 1.336, 95% confidence interval [CI]: 1.050–1.700, P = 0.018) and post-TIPS right atrial pressure (HR = 1.238, 95% CI: 1.015–1.510, P = 0.035) were independent predictors for mortality. The cumulative rates of shunt dysfunction and variceal rebleeding were 11.0% and 28.3% at five years, respectively, and portal venous pressure gradient (HR = 2.572, 95% CI: 1.094–6.047, P = 0.030) was the only independent predictor for shunt dysfunction. The cumulative four-year HE-free rate was 48.6%. No severe adverse event was noted during TIPS procedures. Conclusion: Elective TIPS implantation using Viatorr TIPS stent-grafts is generally safe, and the long-term efficacy is favorable for the treatment of cirrhotic patients with recurrent variceal bleeding or refractory ascites.

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Section: Methodsmentioning

confidence: 99%

“…All patients were treated as previously described before and after TIPS placement [ 12 13 ]. Follow-up visits were conducted through telephone calls or Wechat, outpatient and/or hospital visits that were scheduled at three, six months and then at 6–12 monthly intervals or any time when they felt unwell.…”

Section: Methodsmentioning

confidence: 99%

Elective Transjugular Intrahepatic Portosystemic Shunt Using Viatorr Stent-Grafts: A Single-Center Experience from China

Wan

et al. 2022

Journal of the Belgian Society of Radiology

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“…In addition, the more the portal venous pressure decreased after TIPS, the more obvious the effect of portal-systemic shunt was. The risk of postoperative rebleeding was reduced, but the risk of postoperative HE was increased [13]. At present, there are few studies on the percentage of PPG decline in relation to OHE after TIPS.…”

Section: Discussionmentioning

confidence: 99%

“…Many risky factors, such as advanced age, Child-Pugh score and HE medical history can predict HE after TIPS in PHT patients [12]. The gradient change in portal venous pressure before and after operation is closely related to HE [13]. In addition, stent diameter and preoperative serum albumin level might be independent risk factors for HE in patients after TIPS [14].…”

Section: Introductionmentioning

confidence: 99%

A novel nomogram predicting overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in portal hypertension patients

Liao¹,

Zhang

Yue³

et al. 2023

Preprint

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Rationale and Objectives: We aim to develop a nomogram to predict overt hepatic encephalopathy (OHE) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with portal hypertension, according to demographic/clinical indicators such as age, creatinine, blood ammonia, indocyanine green retention rate at 15 minutes (ICG-R15) and percentage of Portal pressure gradient (PPG) decline. Materials and Methods: In this retrospective study, 296 patients with portal hypertension who received elective TIPS in Beijing Shijitan Hospital from June 2018 to June 2020 were included. These patients were randomly divided into a training cohort (n=207) and a validation cohort (n=89). According to the occurrence of OHE, patients were assigned to OHE group and non-OHE group. Both univariate and multivariate analyses were performed to determine independent variables for predicting OHE after TIPS. Accordingly, receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to compare the accuracy and superiority of a novel model with conventional Child-Pugh and MELD scoring model. Results: Age (OR=1.036, 95% CI:1.002-1.070, p=0.037), Creatinine (OR=1.011, 95% CI:1.003-1.019, p=0.009), Blood ammonia (OR=1.025, 95% CI:1.006-1.044, p=0.011), ICG-R15 (OR=1.030, 95% CI:1.009-1.052, p=0.004) and Percentage decline in PPG (OR=1.068, 95% CI:1.029-1.109, p=0.001) were independent risk factors for OHE after TIPS using multifactorial analysis. A nomogram was constructed using a well-fit calibration curve for each of these five covariates. When compared to Child-Pugh and MELD score, this new nomogram has a better predictive value (C-index=0.828, 95% CI:0.761-0.896). Consistently, this finding was reproduceable in validation cohort and confirmed with DCA. Conclusion: A unique nomogram was developed to predict OHE after TIPS in patients with PHT, with a high prediction sensitivity and specificity performance than commonly applied scoring systems.

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“…TIPS is a minimally invasive interventional therapy to establish a shunt between the PV and HV to control esophageal and gastric variceal bleeding, as well as intractable peritoneal effusion, by decreasing PV hypertension. Increasing evidence has shown that the bleeding control rate of patients with variceal bleeding is 90-100% using the TIPS technique [12][13]. Intrahepatic PV puncture is the most critical step for the success of TIPS.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative cone-beam CT during the transjugular intrahepatic portosystemic shunt procedure

Huang

Liu

Wei

et al. 2022

Preprint

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To evaluate the identification of portal vein (PV) entry by intraoperative cone-beam CT (CBCT) during the transjugular intrahepatic portosystemic shunt (TIPS) procedure. From February 2018 to February 2020, 73 patients underwent TIPS due to severe portal hypertension, and 28 of them underwent intraoperative CBCT angiography. In the CBCT and digital subtraction angiography (DSA) groups, the primary indicators included the number of punctures, PV puncture time, and PV entry scoring and the secondary indicators included shunt angle (SA), contrast volume, and dose area product (DAP) were evaluated, respectively. The number of punctures and PV puncture time in the CBCT group were (2.3 ± 0.9) and (9.2 ± 1.8) min that both less than (4.2 ± 1.5) and (20.4 ± 2.1) min in the DSA group, respectively, and PV entry scoring was better in the CBCT group (all P < 0.05). The DAP was (224.3 ± 46.3) Gy×cm2 in the CBCT group and (180.9 ± 29.3) Gy×cm2 in the DSA group, which showed a significant increase (P < 0.05). However, SA and contrast volume showed no significance between the two groups. Intraoperative CBCT can accurately identify PV entry for some difficult TIPS procedures but results in increased radiation exposure.

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Transjugular Intrahepatic Portosystemic Shunt:The Impact of Portal Venous Pressure Declines on Shunt Patency and Clinical Efficacy

Cited by 11 publications

References 31 publications

Elective Transjugular Intrahepatic Portosystemic Shunt Using Viatorr Stent-Grafts: A Single-Center Experience from China

Elective Transjugular Intrahepatic Portosystemic Shunt Using Viatorr Stent-Grafts: A Single-Center Experience from China

A novel nomogram predicting overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in portal hypertension patients

Intraoperative cone-beam CT during the transjugular intrahepatic portosystemic shunt procedure

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