Pathological Predictors of Shunt Stenosis and Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt

Abstract

Background. Transjugular intrahepatic portosystemic shunt (TIPS) is an artificial channel from the portal vein to the hepatic vein or vena cava for controlling portal vein hypertension. The major drawbacks of TIPS are shunt stenosis and hepatic encephalopathy (HE); previous studies showed that post-TIPS shunt stenosis and HE might be correlated with the pathological features of the liver tissues. Therefore, we analyzed the pathological predictors for clinical outcome, to determine the risk factors for shunt stenosis and HE after TIPS. Methods. We recruited 361 patients who suffered from portal hypertension symptoms and were treated with TIPS from January 2009 to December 2012. Results. Multivariate logistic regression analysis showed that the risk of shunt stenosis was increased with more severe inflammation in the liver tissue (OR, 2.864; 95% CI: 1.466–5.592; P = 0.002), HE comorbidity (OR, 6.266; 95% CI, 3.141–12.501; P < 0.001), or higher MELD score (95% CI, 1.298–1.731; P < 0.001). Higher risk of HE was associated with shunt stenosis comorbidity (OR, 6.266; 95% CI, 3.141–12.501; P < 0.001), higher stage of the liver fibrosis (OR, 2.431; 95% CI, 1.355–4.359; P = 0.003), and higher MELD score (95% CI, 1.711–2.406; P < 0.001). Conclusion. The pathological features can predict individual susceptibility to shunt stenosis and HE.

Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experience

“…Further patient- and procedure-related characteristics (gender, age, underlying liver disease, TIPS indications, Child-Pugh score, MELD score, platelet count, number of stents, stent diameter, portosystemic pressure gradient, and additional variceal embolization) revealed no statistically significant differences between patients who underwent TIPS revision (Group I) as compared to Group II without the necessity of TIPS revision. These data differ from the results of He et al [24] who described a higher MELD score, apart from liver inflammation and hepatic encephalopathy, as a major risk factor for shunt stenosis. By use of the covered Viatorr stentgraft, the necessity for TIPS re-intervention due to stent thrombosis or stenosis within the first 12 months was significantly reduced from 55.8 to 22.2%, a decrease of 33.6% ( p  < 0.01), despite reduced anticoagulation (bare: repeat prescription of acetylsalicylic acid versus covered: none), as compared to bare stents (Fig.…”

Primary constrained TIPS for treating refractory ascites or variceal bleeding secondary to hepatic cirrhosis

“…10 An increased risk of encephalopathy following TIPS is associated with higher preprocedural MELD scores, advanced stage of hepatic fibrosis, pre-TIPS portal venous pressure, older age and pre-existing encephalopathy. [24][25][26][27][28] Prior studies have also uncovered an association between HE and the change in PSG after shunt placement. Findings presented by Haskal et al demonstrated that higher final PSG is associated with reduced incidence of HE.…”

Cranial stent position is independently associated with the development of TIPS dysfunction

“…After years of resolving mostly technical problems, the introduction of polytetrafluoroethylene (PTFE) covered stents in the millennials marked an important development with a reduction but not abolishment of shunt dysfunction, even in smaller stent diameters 2 , 10 – 14 . TIPS dysfunction, stenosis and occlusion, among other factors 15 – 18 , seem to be influenced by the hemodynamic flow characteristics 19 , which themselves are influenced by the geometry of the TIPS stent. In the modern era of PTFE-covered TIPS stents, some studies suggested that characteristics of TIPS stent geometry, such as portal venous inflow, retrieved by two-dimensional (2D) angiography during the procedure might predict TIPS dysfunction 20 , 21 .…”