Use of concomitant variceal embolization and prophylactic antiplatelet/anticoagulative in transjugular intrahepatic portosystemic shunting

Abstract

Transjugular intrahepatic portosystemic shunting (TIPS) is an effective treatment modality for refractory variceal bleeding and ascites in patients with cirrhotic portal hypertension (CPH). Variceal rebleeding and shunt dysfunction are major post-TIPS morbidities. This study aimed to retrospectively evaluate the effectiveness and safety of use of concomitant variceal embolization and prophylactic antiplatelet/anticoagulative in patients with CPH undergoing TIPS. Between October 2006 and October 2011, 182 patients with CPH were retrospectively and consecutively hospitalized for elective TIPS with Fluency stenting. Concomitant variceal embolization was given after establishing the shunt. Subcutaneous heparin was given after TIPS and replaced by oral clopidogrel, aspirin, or warfarin for at least 6 months. Main outcome measures included shunt patency rate, recurrence of CPH (rebleeding and/or refractory ascites), hepatic encephalopathy (HE) frequency, and post-TIPS survival. The cumulative primary patency rate was 96%, 94%, 90%, 88%, and 88% at 6, 12, 24, 36, and 48 months, respectively. Shunt stenosis occurred in 16 (9%) patients, gastrointestinal (GI) rebleeding in 32 (17.5%) patients, recurrence of refractory ascites 44 (48%) patients, HE in 42 (23%) patients, and death in 36 (20%) patients during the follow-up period. Use of concomitant variceal embolization and prophylactic antiplatelet/anticoagulative was associated with a favorable shunt patency and a low risk of GI rebleeding.

Glue Embolization of Gastroesophageal Varices during Transjugular Intrahepatic Portosystemic Shunt (TIPS) Improves Survival Compared to Coil-only Embolization—A Single-Center Retrospective Study

“…It is an established fact that closure of GEV in patients with variceal bleeding in combination with TIPS lowers rebleeding rates [13,24]. Moreover, recent data suggest presence of SPSS impacts outcome of cirrhotic patients [15], suggesting that efficient, overall shunt reduction is warranted in this patient group.…”

“…During TIPS collateral vein embolization may further reduce rebleeding rate [10] and rates of hepatic encephalopathy (HE) [11,12] development. Moreover, a reduction of the collateral blood flow via varicose vessels may improve TIPS flow and thereby TIPS patency [13,14]. The hypothesis that embolization of shunts might have an impact on patient outcome, is also supported by the fact that the presence of spontaneous portosystemic shunts (SPSS) has recently been shown to increase rates of decompensation [15].…”

Multidisciplinary Management of Hepatic Hydrothorax in 2020: An Evidence‐Based Review and Guidance

“…(61,62) The incidence of post-TIPS encephalopathy can be minimized by dilating the shunt to 8 mm rather than 10 mm. (63) Late complications include shunt stenosis or thrombosis requiring revision, although the incidence of these complications is decreasing with widespread adoption of covered stents over uncovered stents. (53,64) Risk of mortality after TIPS can be predicted by assessing one of many patient factors.…”

Refractory portal hypertension complications successfully managed by parallel transjugular intrahepatic portosystemic shunt (TIPS): a case report

“…As such, certain patients may benefit from variceal embolization alongside parallel TIPS creation. (Tang et al 2017 )…”