Emergency transjugular intrahepatic portosystemic shunt (TIPS): results, complications and predictors of mortality in the first month of follow-up

Gazzera, Carlo; Righi, Dorico; Breatta, Andrea Doriguzzi; Rossato, Denis; Camerano, Francesco; Valle, Francisco del; Gandini, Giovanni

doi:10.1007/s11547-011-0682-9

Cited by 23 publications

(11 citation statements)

References 25 publications

(38 reference statements)

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“…The TIPS procedure was performed during the night shift in 38.3%, and 55.7% of patients had variceal embolization during the procedure. Median portal pressure gradient before TIPS was 18 mm Hg (15)(16)(17)(18)(19)(20)(21)(22) and 7 mm Hg (5-10) after TIPS placement with a portal pressure delta of 11 mm Hg (8)(9)(10)(11)(12)(13). No death was related to the TIPS procedure.…”

Section: Characteristics Of the Derivation Cohortmentioning

confidence: 92%

Combination of Model for End‐Stage Liver Disease and Lactate Predicts Death in Patients Treated With Salvage Transjugular Intrahepatic Portosystemic Shunt for Refractory Variceal Bleeding

et al. 2021

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Background and Aims Data about the prognosis of salvage transjugular intrahepatic portosystemic shunt (TIPS) using covered stents for refractory variceal bleeding caused by portal hypertension are scarce. We aimed to assess survival and to identify predictors of mortality in these patients. Approach and Results One hundred sixty‐four patients with cirrhosis from five centers treated with salvage TIPS between 2007 and 2017 were retrospectively divided into a derivation cohort (83 patients) and a validation cohort (81 patients). Comparisons were performed using the Mann‐Whitney and Fischer’s exact test. Six‐week overall survival (OS) was correlated with variables on the day of the TIPS using Kaplan‐Meier curves with log‐rank test and univariate/multivariate analyses using the Cox model. Eighty‐three patients were included in the derivation cohort (male, 78%; age, 55 years, alcohol‐associated cirrhosis, 88%; Model for End‐Stage Liver Disease [MELD], 19 [15‐27]; arterial lactate, 3.7 mmol/L [2.0‐8.3]). Six‐week OS rate was 58%. At multivariate analysis, the MELD score (OR, 1.064; 95% CI, 1.005‐1.126; P = 0.028) and arterial lactate (OR, 1.063; 95% CI, 1.013‐1.114; P = 0.032) were associated with 6‐week OS. Six‐week OS rates were 100% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15 and 5% in patients with lactate ≥12 mmol/L and/or MELD score ≥ 30. The 81 patients of the validation cohort had similar MELD and arterial lactate level but lower creatinine level (94 vs 106 µmol/L, P = 0.008); 6‐week OS was 67%. Six‐week OS rates were 86% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15 and 10% for patients with lactate ≥12 mmol/L and/or MELD score ≥ 30. In the overall cohort, rebleeding rate was 15.8% at 6 weeks, and the acute‐on‐chronic liver failure grade (OR, 1.699; 95% CI, 1.056‐1.663; P = 0.040) was independently associated with rebleeding. Conclusions After salvage TIPS, 6‐week mortality remains high and can be predicted by MELD score and lactate. Survival rate at 6 weeks was >85% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15, while mortality was >90% for lactate ≥12 mmol/L and/or MELD score ≥ 30.

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Section: Characteristics Of the Derivation Cohortmentioning

confidence: 92%

Combination of Model for End‐Stage Liver Disease and Lactate Predicts Death in Patients Treated With Salvage Transjugular Intrahepatic Portosystemic Shunt for Refractory Variceal Bleeding

et al. 2021

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“…Aside from procedure-related complications, clinical outcomes are most strongly determined by preprocedure status, including measures such as the Model for End-stage Liver Disease score and its modifications, Acute Physiology and Chronic Health Evaluation II score, and Emory score (3)(4)(5)(6)(7)(8)(9)(10). In addition, patient age, urgency of the procedure, preprocedure hepatic venous pressure gradient, pre-and post-TIPS liver function test results (eg, serum bilirubin), right atrial pressure, and diastolic function have been shown to correlate with or predict survival after TIPS creation (11)(12)(13)(14)(15). Many of these factors are also predictors for the development of hepatic encephalopathy (HE) following TIPS creation.…”

Section: Clinical Outcomes and Prognostic Factorsmentioning

confidence: 99%

Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunts

Dariushnia

Haskal

Midia

et al. 2016

Journal of Vascular and Interventional Radiology

163

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The membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee represents experts in a broad spectrum of interventional procedures from the private and academic sectors of medicine. Generally, Standards of Practice Committee members dedicate the vast majority of their professional time to performing interventional procedures; as such, they represent a valid, broad expert constituency on the subject matter under consideration for standards production. METHODOLOGYSIR produces its Standards of Practice documents using the following process. Standards documents of relevance and timeliness are conceptualized by the Standards of Practice Committee members. A recognized expert is identified to serve as the principal author for the document. Additional authors may be assigned depending on the magnitude of the project.An in-depth literature search is performed with use of electronic medical literature databases. Then, a critical review of peer-reviewed articles is performed regarding the study methodology, results, and conclusions. The qualitative weight of these articles is assembled into an evidence table, which is used to write the document such that it contains evidence-based data with respect to content, rates, and thresholds.When the evidence of literature is weak, conflicting, or contradictory, consensus for the parameter is reached by a minimum of 12 Standards of Practice Committee members using a modified Delphi consensus method (Appendix A). For the purpose of these documents, consensus is defined as 80% Delphi participant agreement on a value or parameter.The draft document is critically reviewed by the Standards of Practice Committee members in a telephone conference call or face-toface meeting. The finalized draft from the Committee is sent to the SIR membership for further input/criticism during a 30-day comment period. These comments are discussed by the Standards of Practice Committee, and appropriate revisions are made to create the finished standards document. Before its publication, the document is endorsed by the SIR Executive Council.

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“…15 TIPS is typically preferred over surgery (particularly in patients with poor liver function), as operative mortality may be high in cirrhotic patients, although acute emergent variceal hemorrhage may be associated with significant mortality irrespective of treatment modality. 16,17 Established and Emerging Indications for TIPS in Variceal Hemorrhage Current indications for TIPS creation in the context of gastroesophageal varices include the prevention of recurrent variceal hemorrhage in patients who demonstrate intolerance or resistance to medical and endoscopic treatment 18 ; TIPS is not advocated, however, for prevention of rebleeding in patients who have bled only once from esophageal varices. 18 TIPS is also recommended as rescue therapy in cases of refractory acute bleeding, 18 although recent data support a broader role for TIPS as first-line treatment for acute hemorrhage.…”

Section: Diagnosis and Managementmentioning

confidence: 99%

Outcomes of TIPS for Treatment of Gastroesophageal Variceal Hemorrhage

Parvinian

Gaba

2014

Semin intervent Radiol

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Objectives: Upon completion of this article, the reader will be able to describe variceal pathophysiology and conventional management, discuss current and emerging transjugular intrahepatic portosystemic shunt (TIPS) indications, identify TIPS clinical outcomes, and explain the role of adjuvant embolotherapy.Accreditation: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Tufts University School of Medicine (TUSM) and Thieme Medical Publishers, New York. TUSM is accredited by the ACCME to provide continuing medical education for physicians.Credit: Tufts University School of Medicine designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.Variceal hemorrhage is a catastrophic consequence of portal hypertension and a leading cause of death among cirrhotic patients. Management of this condition requires a multidisciplinary approach that emphasizes early detection and encompasses pharmacologic, endoscopic, surgical, and image-guided interventional therapies. This review focuses on the role of the transjugular intrahepatic portosystemic shunt (TIPS) procedure in the context of variceal hemorrhage, with emphasis on variceal pathophysiology and conventional management, current and emerging TIPS indications, TIPS clinical outcomes, and the role of adjuvant embolotherapy. Variceal Hemorrhage Pathophysiology and EpidemiologyThe hyperdynamic circulation and portal venous congestion attendant to longstanding liver cirrhosis contribute to the formation of esophageal and gastric varices, particularly in the presence of a hepatic venous pressure gradient exceeding 10 mm Hg. 1 Roughly 30 to 40% of compensated cirrhotic patients and 60% of decompensated cirrhotic patients present with esophageal varices at the time of diagnosis. 2 Gastric varices are less common, occurring in roughly 20% of patients with portal hypertension, but are associated with more AbstractVariceal hemorrhage is a life-threatening complication of cirrhosis that requires a multidisciplinary approach to management. The transjugular intrahepatic portosystemic shunt (TIPS) procedure is a minimally invasive image-guided intervention used for secondary prevention of bleeding and as salvage therapy in acute hemorrhage. This review focuses on the role of TIPS in the setting of variceal hemorrhage, with emphasis on the pathophysiology and conventional management of variceal hemorrhage, current and emerging indications for TIPS creation, TIPS clinical outcomes, and the role of adjuvant embolotherapy.

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Emergency transjugular intrahepatic portosystemic shunt (TIPS): results, complications and predictors of mortality in the first month of follow-up

Abstract: The technical success of TIPS may not lead to haemodynamic and clinical success. Complications are often due to impaired coagulation and inadequacy of the stent-graft. Early mortality is only influenced by pre-existing clinical and laboratory factors.

Cited by 23 publications

References 25 publications

Combination of Model for End‐Stage Liver Disease and Lactate Predicts Death in Patients Treated With Salvage Transjugular Intrahepatic Portosystemic Shunt for Refractory Variceal Bleeding

Combination of Model for End‐Stage Liver Disease and Lactate Predicts Death in Patients Treated With Salvage Transjugular Intrahepatic Portosystemic Shunt for Refractory Variceal Bleeding

Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunts

Outcomes of TIPS for Treatment of Gastroesophageal Variceal Hemorrhage

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