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

Abstract

OBJECTIVE:

To report an initial experience using a primary constrained transjugular intrahepatic portosystemic shunt (TIPS) technique for treating cirrhotic patients with refractory ascites or variceal bleeding.

METHODS:

All patients undergoing primary constrained (n = 9) and conventional (n = 18) TIPS between July 2014 and June 2016 were retrospectively reviewed. Preprocedure demographics, Child-Pugh, model for end-stage liver disease and technical variables were recorded. Outcomes measured included technical and clinical success, complications, 30-day mortality, as well as necessity for TIPS revision. Average (SD) and median follow-up was 237 (190) and 226 days.

RESULTS:

All constrained and conventional TIPS were technically successful (100%). Clinical success as defined as a reduction or improvement in presenting symptoms was 88.9% (8/9) and 100% (18/18) in the constrained and conventional groups, respectively (p = 1). The average reduction in portosystemic gradient was lower in the constrained group, 6.1 mmHg compared with 10.6 mmHg in the conventional group (p = 0.73). The rate of hepatic encephalopathy following TIPS placement was higher in the conventional group [16.7% (3/18)] compared with 0% in the constrained group (p = 0.52). The percentage of patients requiring TIPS revision was lower in the constrained group, although the results were not significant (11.1 vs 22.2%, p = 0.63).

CONCLUSION:

Primary constrained TIPS is a feasible modification to conventional TIPS with similar technical and clinical success rates. A trend towards a smaller reduction in the portosystemic gradient and need for revision was observed in the constrained group. Advances in knowledge: Primary constrained TIPS allows for greater stepwise control over shunt diameter and may represent an improved technique for patients at risk for hepatic encephalopathy.

• Authors: R Rabei, S Mathevosian, J Tasse, S Madassery, B Arslan, U Turba, O Ahmed
• Journal: The British journal of radiology (Br J Radiol) Vol. 91 Issue 1083 Pg. 20170409 (02 2018) ISSN: 1748-880X [Electronic] England
• PMID: 29166137 (Publication Type: Journal Article)

Topics

• Ascites (etiology, surgery)
• Esophageal and Gastric Varices (etiology, surgery)
• Female
• Humans
• Liver Cirrhosis (complications)
• Male
• Middle Aged
• Portasystemic Shunt, Transjugular Intrahepatic (methods)
• Radiography, Interventional
• Treatment Outcome