Covered TIPS Procedure-Related Major Complications: Incidence, Management and Outcome From a Single Center

Abstract

Background and ObjectiveTransjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure for treating complications of portal hypertension. Due to the complexity of anatomy and difficulty of the puncture technique, the procedure itself might brought potential complications, such as puncture failure, bleeding, infection, and, rarely, death. The aim of this study is to explore the incidence, management, and outcome of TIPS procedure-related major complications using covered stents.MethodsPatients who underwent TIPS implantation from January 2015 to December 2020 were recruited retrospectively. Major complications after TIPS were screened and analyzed.ResultsNine hundred and forty-eight patients underwent the TIPS procedure with 95.1% (n = 902) technical success in our department. TIPS procedure-related major complications occurred in 30 (3.2%) patients, including hemobilia (n = 13; 1.37%), hemoperitoneum (n = 7; 0.74%), accelerated liver failure (n = 6; 0.63%), and rapidly progressive organ failure (n = 4; 0.42%). Among them, 8 patients died because of hemobilia (n = 1), accelerated liver failure (n = 4), and rapidly progressive organ failure (n = 3).ConclusionThe incidence of major complications related to TIPS procedure is relatively low, and some of them could recover through effective medical intervention. In our cohort, the overall incidence is about 3%, which causes 0.84% death. The most fatal complication is organ failure and hemobilia.

Biliary Complications Post Transjugular Intrahepatic Portosystemic Shunt in a Child With Portal Vein Cavernous Transformation

“…It is achieved successfully in more than 90% of cases. TIPS complications can be classified as related to the procedure or the stent and are around 3% but reported as 20%, with derived mortality at 0.84% [ 3 , 4 , 9 , 10 ].…”

Management of inadvertent puncture of the hepatic capsule accompanied by post-TIPS hemoperitoneum secondary to bleeding diathesis

“…A study by Yin et al. [9] reported that the incidence of major post-TIPS complications occurred in about 3.2% of patients while 0.74% experienced hemoperitoneum out of a total of 948 patients. In yet another study by Dariushnia et al.…”

“…Another study by Griffin et al. reported that out of 71 patients who underwent the TIPS procedure, inadvertent puncture of the liver capsule occurred in 4 patients, with one of them developing hemoperitoneum [9] .…”

AASLD Practice Guidance on the use of TIPS, variceal embolization, and retrograde transvenous obliteration in the management of variceal hemorrhage

“…Procedural complications during TIPS are rare (<5%) in contemporary series 45,46 but may include intraperitoneal bleeding, arterial injury, liver infarct, hepatic capsular puncture, hemobilia, immediate TIPS thrombosis, and sepsis 47,48 . Procedure-related deaths occur in <1% 46 …”