High Incidence of Hepatic Encephalopathy After Viatorr Controlled Expansion Transjugular Intrahepatic Portosystemic Shunt Creation

Kloster, M.; Ren, Albert; Shah, Ketan Y.; Alqadi, Murad M.; Bui, James T.; Lipnik, Andrew J.; Niemeyer, Matthew M.; Ray, Charles E.; Gaba, Ron C.

doi:10.1007/s10620-020-06716-2

Cited by 15 publications

(7 citation statements)

References 15 publications

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“…However, few studies on post-TIPS liver failure report that patients typically present with marked elevation in liver function test values and severe coagulopathy. Liver failure (LF) after TIPS is rare and frequently ignored, but it is often fatal once it occurs ( 18 ). Therefore, preprocedural assessment and patient selection are crucial for minimizing this complication, and it may be beyond saving, the aim of this study was to identify possible study complications.…”

Section: Discussionmentioning

confidence: 99%

Hepatic venous pressure gradient (HVPG) predicts liver failure after transjugular intrahepatic portal shunt: a retrospective cohort study

Yao¹,

Fernandes²,

Ramírez-Fernández³

et al. 2022

Ann Transl Med

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Background: Esophagogastric variceal bleeding is a serious complication of decompensated cirrhosis.Transjugular intrahepatic portal shunt (TIPS) is a salvage treatment with clear hemostatic results. However, various complications may occur after TIPS, including postoperative liver failure, and the prognosis is very poor once occurs. Liver failure is a common symptom of severe liver disease with a high mortality rate. This study investigated the incidence of liver failure after TIPS treatment for varicose bleeding.Methods: We analyzed the data of patients admitted to the First Affiliated Hospital of Soochow University between January 2013 and December 2018 with portal hypertension with an episode of acute gastroesophageal variceal bleeding. A total of 121 patients were referred to the regional liver unit for TIPS.Hepatic venous pressure gradient (HVPG) and clinical data were collected. Patients with incomplete data were excluded, and 93 patients were ultimately enrolled in the study. Primary outcomes were morbidity and hospital mortality within 4 weeks of surgery. The data were retrospectively and consecutively collected and evaluated by univariate and multivariate analyses to identify risk factors of liver failure. Results:The patients included 58 males (62.37%) and 35 females (37.63%), and the mean age was 58.43±11.85 years. The main cause was hepatitis B virus (HBV), which was found in 50.54% of patient. The overall surgical success rate was 83.87% (78/93). Of 15 treatment-failure patients, 9 (9.68%) died in hospital.Four patients died of liver failure, accounting for 44.44% of postoperative all-cause deaths. Univariate logistic regression analysis showed that only hepatic venous pressure gradient (HVPG) was an independent risk factor for post-TIPS morbidity [relative risk (RR) 1.156; 95% confidence interval (CI): 1.041 to 1.283; P=0.006]. In addition, HVPG was an independent risk factor for hospital mortality within 4 weeks (RR 1.133; 95% CI: 1.021 to 0.539; P=0.016).Conclusions: Post-TIPS liver failure is a serious complication in patients with cirrhosis. Pre-TIPS HVPG level may be used as a predictor of potential short-term postoperative adverse events.

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Section: Discussionmentioning

confidence: 99%

Hepatic venous pressure gradient (HVPG) predicts liver failure after transjugular intrahepatic portal shunt: a retrospective cohort study

Yao¹,

Fernandes²,

Ramírez-Fernández³

et al. 2022

Ann Transl Med

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“…Existing literature on the topic is conflicting, as an early retrospective study demonstrated high rates of hepatic encephalopathy with the VCX stent. Kloster et al [9] however, a more recent prospective study reported improved survival using VCX for TIPS when compared with underdilated 10 mm Via-torrÒ stents [10].…”

Section: Dear Editormentioning

confidence: 98%

Transjugular Intrahepatic Portosystemic Shunt Placement: Entering the Era of Controlled Expansion

Ahmed

2023

Cardiovasc Intervent Radiol

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“…In a single-center retrospective study of 33 patients, post-TIPS HE was observed in 61% of patients receiving VCX for refractory ascites and variceal bleeding. 36 However, 33% of patients had HE prior to TIPS placement and only 82% received post-TIPS lactulose or rifaximin. Mean post-PSPG of 6 mm Hg was slightly lower compared to prior studies utilizing 8-mm stents ( Table 1 ).…”

Section: Controlled Expansion Stentsmentioning

confidence: 99%

Smaller Diameter and Adjustable Diameter Transjugular Intrahepatic Portosystemic Shunts

Gupta

Sze

Rigas

2023

Semin intervent Radiol

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Complications of overshunting, including hepatic encephalopathy and hepatic insufficiency, remain prevalent following transjugular intrahepatic portosystemic shunt (TIPS) creation. Smaller diameter TIPS may reduce the risk of overshunting, but the use of smaller stents must be weighed against the risk of undershunting and persistent or recurrent hemorrhage, ascites, and other complications of portal hypertension. This article explores the question of optimal shunt diameter by examining outcomes for smaller diameter TIPS stent-grafts (<10 mm), underdilated stent-grafts, and variable diameter stent-grafts.

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High Incidence of Hepatic Encephalopathy After Viatorr Controlled Expansion Transjugular Intrahepatic Portosystemic Shunt Creation

Cited by 15 publications

References 15 publications

Hepatic venous pressure gradient (HVPG) predicts liver failure after transjugular intrahepatic portal shunt: a retrospective cohort study

Hepatic venous pressure gradient (HVPG) predicts liver failure after transjugular intrahepatic portal shunt: a retrospective cohort study

Transjugular Intrahepatic Portosystemic Shunt Placement: Entering the Era of Controlled Expansion

Smaller Diameter and Adjustable Diameter Transjugular Intrahepatic Portosystemic Shunts

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