Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients

Dajti, Elton; Renzulli, Matteo; Colecchia, Antonio; Bacchi-Reggiani, M.L.; Milandri, M; Rossini, Benedetta; Ravaioli, Federico; Marasco, Giovanni; Alemanni, Luigina Vanessa; Ierardi, Anna Maria; Carrafiello, Gianpaolo; Pinzani, Massimo; Azzaroli, Francesco; Mazzella, Giuseppe; Golfieri, Rita; Festi, Davide

doi:10.1016/j.dld.2020.12.114

Cited by 24 publications

(26 citation statements)

References 28 publications

(30 reference statements)

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“…Another retrospective database review reported that 63.5% of patients had SPSS and 18% had a shunt diameter of 1 cm or more [46]. Similarily, a retrospective cohort study of 235 patients found SPSS in 141 patients (60%) [47]. e authors of this study also reported that although the prevalence of SPSS increased with the worsening of liver function or portal hypertension, it remained high (46%-55%) even in the subgroups of patients with compensated cirrhosis, preserved liver function (Model for End-Stage Liver Disease or MELD <10), or liver stiffness measurement <21 kPa, suggesting that SPSS may be commonly found even in early stages of cirrhosis.…”

Section: Prevalence Of Spssmentioning

confidence: 63%

“…A significant percentage of patients-between 20% and 25%-had more than one SPSS. Interestingly, splenorenal shunt was the most commonly found large SPSS, while Canadian Journal of Gastroenterology and Hepatology RPUV was the most frequently seen SPSS when the size criterion was not considered [8,46,47]. ere appears to be some association between the etiology of liver cirrhosis and the presence of SPSS.…”

Section: Prevalence Of Spssmentioning

confidence: 99%

“…A significant percentage of patients—between 20% and 25%—had more than one SPSS. Interestingly, splenorenal shunt was the most commonly found large SPSS, while RPUV was the most frequently seen SPSS when the size criterion was not considered [ 8 , 46 , 47 ].…”

Section: Types Of Shunts and Their Reported Clinical Associationsmentioning

confidence: 99%

“…However, in a recent retrospective cohort study, it was reported that the higher risk of SPSS in nonviral etiology was independent of liver function or portal pressure. The authors attributed this finding to the different patterns of fibrogenesis and severity of portal hypertension described in the various etiologies of liver cirrhosis [ 47 ].…”

Section: Types Of Shunts and Their Reported Clinical Associationsmentioning

confidence: 99%

“…However, Praktiknjo et al recently used the sum of the cross-sectional areas of all SPSSs identified, reporting that a large SPSS area (>83 mm 2 ) was associated with worse survival [ 51 ]. In addition, another recent retrospective cohort study of 235 advanced chronic liver disease patients found that the presence, size, and number of SPSS predicts the risk of decompensation across all stages of cirrhosis [ 47 ]. SPSS presence was associated with a 2.3-fold increase in the risk of any event of decompensation.…”

Section: Types Of Shunts and Their Reported Clinical Associationsmentioning

confidence: 99%

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Friend or Foe? Spontaneous Portosystemic Shunts in Cirrhosis—Current Understanding and Future Prospects

Rajesh

Philips

Ahamed

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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Portal hypertension (PHT) in cirrhosis results from increased resistance to splanchnic blood flow secondary to parenchymal and vascular changes within the liver. In an attempt to counteract the increased portal pressure, two mechanisms simultaneously occur: splanchnic vasodilatation and formation of spontaneous portosystemic shunts (SPSS). Long considered to be a compensatory mechanism to decompress the portal venous system, it is now well established that SPSS are not only inefficient in decreasing the portal pressure but also contribute to reduced hepatocyte perfusion and increased splanchnic blood flow and resistance, associated with worsening PHT. Recent studies have described a high prevalence of SPSS in cirrhosis patients, increasing with liver dysfunction, and observed an association between the presence of SPSS and worse clinical outcomes. In cirrhosis patients with preserved liver functions, the presence of SPSS independently increases the risk of hepatic encephalopathy, variceal bleeding, and ascites, and reduces transplant-free survival. Moreover, the presence of SPSS in patients undergoing transjugular intrahepatic portosystemic shunting and liver transplant has been shown to variably affect the postprocedural outcome. This article provides an overview of the current understanding of the role of SPSS in the natural history of liver cirrhosis and their status as a therapeutic target and an imaging biomarker to identify patients at higher risk of developing complications of PHT.

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Section: Prevalence Of Spssmentioning

confidence: 63%

Section: Prevalence Of Spssmentioning

confidence: 99%

Section: Types Of Shunts and Their Reported Clinical Associationsmentioning

confidence: 99%

Section: Types Of Shunts and Their Reported Clinical Associationsmentioning

confidence: 99%

Section: Types Of Shunts and Their Reported Clinical Associationsmentioning

confidence: 99%

See 3 more Smart Citations

Friend or Foe? Spontaneous Portosystemic Shunts in Cirrhosis—Current Understanding and Future Prospects

Rajesh

Philips

Ahamed

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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Concurrent large spontaneous portosystemic shunt embolization for the prevention of overt hepatic encephalopathy after TIPS: A randomized controlled trial

Chen

Luo

et al. 2022

Hepatology

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Background and Aims Large spontaneous portosystemic shunt (SPSS) is associated with increased risk of HE in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS). This study aimed to evaluate whether prophylactic embolization of large SPSS at the time of TIPS creation could reduce the incidence of post‐TIPS HE in patients with cirrhosis and variceal bleeding. Approach and Results From June 2014 to August 2017, 56 patients with cirrhosis and large SPSS planning to undergo TIPS for the prevention of variceal bleeding were randomly assigned (1:1) to receive TIPS alone (TIPS group, n = 29) or TIPS plus simultaneous SPSS embolization (TIPS+E group, n = 27). The primary endpoint was overt HE. TIPS placement and SPSS embolization was successful in all patients. During a median follow‐up of 24 months, the primary endpoint was met in 15 patients (51.7%) in the TIPS group and six patients (22.2%) in the TIPS+E group (p = 0.045). The 2‐year cumulative incidence of overt HE was significantly lower in the TIPS+E group compared with the TIPS group (21.2% vs. 48.3%; HR, 0.38; 95% CI, 0.15–0.97; p = 0.043). The 2‐year incidence of recurrent bleeding (TIPS+E vs. TIPS, 15.4% vs. 25.1%; p = 0.522), shunt dysfunction (12.3% vs. 18.6%, p = 0.593), death (15.0% vs. 6.9%, p = 0.352), and other adverse events was not significantly different between the two groups. Conclusions In patients with cirrhosis treated with TIPS for variceal bleeding, concurrent large SPSS embolization reduced the risk for overt HE without increasing other complications. Concurrent large SPSS embolization should therefore be considered for prophylaxis of post‐TIPS HE.

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Spontaneous portosystemic shunt diameter predicts liver function after balloon‐occluded retrograde transvenous obliteration

et al. 2022

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Background and Aim Recently, balloon‐occluded retrograde transvenous obliteration (BRTO), performed for spontaneous portosystemic shunts (SPSS), has been receiving attention as a measure to improve liver function in cirrhotic patients with portal hypertension. However, it is unclear whether SPSS diameter is associated with changes in hepatic venous pressure gradient (HVPG) and liver function after BRTO. Methods In 34 cirrhotic patients receiving BRTO for hepatic encephalopathy/gastric varices, the association of SPSS diameter with liver function at baseline and 6 months after BRTO and the accompanying changes in HVPG were investigated. Results Patients had Child–Pugh (CP) scores of A/B/C (7/19/8), SPSS diameters of ≤10 mm/11–20 mm/<20 mm (8/21/5), and an average observation period of 3.2 (0.3–8.5) years. SPSS diameter was significantly associated with male sex, alcohol use, and values of albumin, prothrombin time (PT%), and NH3 at baseline. Moreover, the SPSS diameter was significantly correlated with the changes in HVPG observed upon BRTO (r = 0.55, P = 0.005), and a large shunt diameter was significantly associated with a greater increase in HVPG. At 6 months, significant improvements in albumin, PT%, bilirubin, and NH3 were observed overall, but the improvement was marked in those with larger shunt diameters if they had CP A/B. Conclusion SPSS diameter was strongly associated with liver function at baseline and after BRTO and also with changes in HVPG, indicating that SPSS diameter is an important predictor of BRTO outcome.

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Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients

Cited by 24 publications

References 28 publications

Friend or Foe? Spontaneous Portosystemic Shunts in Cirrhosis—Current Understanding and Future Prospects

Friend or Foe? Spontaneous Portosystemic Shunts in Cirrhosis—Current Understanding and Future Prospects

Concurrent large spontaneous portosystemic shunt embolization for the prevention of overt hepatic encephalopathy after TIPS: A randomized controlled trial

Spontaneous portosystemic shunt diameter predicts liver function after balloon‐occluded retrograde transvenous obliteration

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