Transjugular Intrahepatic Portosystemic Shunt Complications: Prevention and Management

Suhocki, Paul V.; Lungren, Matthew P.; Kapoor, Baljendra; Kim, Charles Y.

doi:10.1055/s-0035-1549376

Cited by 95 publications

(92 citation statements)

References 73 publications

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“…Early TIPS occlusion within the first 10 days was documented in 6 out of 88 patients (6.8%). According to published evidence, this acute shunt thrombosis is reported in approximately 5% of TIPS insertions [20]. With bare metal stents, acute TIPS occlusion is often thought to be related to biliary-venous fistulas, given the thrombogenicity of bile.…”

Section: Discussionmentioning

confidence: 99%

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

Buechter¹,

Manka²,

Gerken³

et al. 2018

Dig Dis

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Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in decompensated portal hypertension. TIPS revision due to thrombosis or stenosis increases morbidity and mortality. Our aim was to investigate patient- and procedure-associated risk factors for TIPS-revision. Patients and Methods: We retrospectively evaluated 189 patients who underwent the TIPS procedure. Only patients who required TIPS revision within 1 year (Group I, 34 patients) and patients who did not require re-intervention within the first year (Group II [control group], 54 patients) were included. Results: Out of 88 patients, the majority were male (69.3%) and mean age was 56 ± 11 years. Indications for TIPS were refractory ascites (68%), bleeding (24%), and Budd-Chiari syndrome (8%). The most frequent liver disease was alcohol-induced cirrhosis (60%). Forty-three patients (49%) received bare and 45 patients (51%) covered stents, thus resulting in reduction of hepatic venous pressure gradient (HVPG) from 19.0 to 9.0 mm Hg. When comparing patient- and procedure-related factors, the type of stent (p < 0.01) and interventionalist’s experience (number of performed TIPS implantations per year; p < 0.05) were the only factors affecting the risk of re-intervention due to stent dysfunction, while age, gender, indication, Child-Pugh, and model of end-stage liver disease score, platelet count, pre- and post-HVPG, additional variceal embolization, stent diameter, and number of stents did not significantly differ. Conclusion: Patients undergoing TIPS procedure should be surveilled closely for shunt dysfunction while covered stents and high-level experience are associated with increased patency.

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Section: Discussionmentioning

confidence: 99%

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

Buechter¹,

Manka²,

Gerken³

et al. 2018

Dig Dis

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“…Previous studies suggest that stent thrombosis, bile leakage, and pseudo-intima hyperplasia may be the major causes of stenosis of shunt using bare stent [10–12]. Covered stents have been routinely applied in TIPS procedures and have greatly increased the 1-year patency rate to 90–95% [13].…”

Section: Discussionmentioning

confidence: 99%

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

Dai

Xiao

et al. 2016

BioMed Research International

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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.

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“…In patients with HH, undergoing TIPS and having a longer length of stay during index admission was associated with increased risk of readmission. TIPS likely prompted readmission given complications such as hepatic encephalopathy or thrombosis of TIPS . Longer length of stay has been associated with readmission in many disease states, as it likely serves as a marker of increased complications and disease severity during index admission .…”

Section: Discussionmentioning

confidence: 99%

“…TIPS likely prompted readmission given complications such as hepatic encephalopathy or thrombosis of TIPS. 31 Longer length of stay has been associated with readmission in many disease states, as it likely serves as a marker of increased complications and disease severity during index admission. 32 Given that thoracentesis does not improve 30-day readmission in patients with HH, other interventions should be considered for management that would reduce the risk of readmission.…”

Section: Discussionmentioning

confidence: 99%

Management of hepatic hydrothorax and effect on length of stay, mortality, cost, and 30‐day hospital readmission

Sobotka

Spitzer

Hinton

et al. 2019

J of Gastro and Hepatol

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Background and Aim Cirrhosis‐related complications are associated with high inpatient mortality, cost, and length of stay. There is a lack of multi‐centered studies on interventions for hepatic hydrothorax and its impact on patient outcomes. The aim of this study was to determine the effect of performing thoracentesis for hepatic hydrothorax on hospital length of stay, mortality, cost, and 30‐day readmission. Methods A retrospective analysis of the Nationwide Inpatient Sample between 2002 and 2013 and Nationwide Readmission Database during 2013 was performed including patients with a primary diagnosis of hydrothorax or pleural effusion and a secondary diagnosis of cirrhosis based on International Classification of Disease 9 codes. Univariate and multivariate analyses were performed to determine the effect of thoracentesis on patient outcomes during their hospital stay. Results Of the 37 443 patients included from the Nationwide Inpatient Sample, 26 889 (72%) patients underwent thoracentesis. Thoracentesis was associated with a longer length of stay (4.56 days, 95% confidence interval [CI]: 2.40–6.72) and higher total cost ($9449, 95% CI: 3706–15 191). There was no significant difference in inpatient mortality between patients who underwent thoracentesis compared with those who did not. Of the 2371 patients included from the Nationwide Readmission Database, 870 (33%) were readmitted within 30 days. Thoracentesis was not a predictor of readmission; however, transjugular intrahepatic portosystemic shunt (odds ratio: 4.89, 95% CI: 1.17–20.39) and length of stay (odds ratio: 1.02, 95% CI: 1.001–1.05) on index admission were predictors of readmission. Conclusion When considering treatment for hepatic hydrothorax, many factors should contribute to determining the best intervention. While performing thoracentesis may provide immediate relief to symptomatic patients, it should not be considered a long‐term intervention given that it increases hospital cost, was associated with longer length of stays, and did not improve mortality.

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Transjugular Intrahepatic Portosystemic Shunt Complications: Prevention and Management

Cited by 95 publications

References 73 publications

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

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

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

Management of hepatic hydrothorax and effect on length of stay, mortality, cost, and 30‐day hospital readmission

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