Abstract | PURPOSE: METHODS: Fifty-five patients underwent TIPS creation for refractory ascites. Subjects underwent creation of 8 mm TIPS followed by proximal splenic artery embolization (group A, n=8), or of 8 mm (group B, n=6) or 10 mm TIPS (group C, n=41) without splenic embolization. Data were retrospectively reviewed. RESULTS: In group A, median portosystemic gradient decreased from 19 mmHg to 9 mmHg after TIPS, and 8 mmHg after subsequent splenic artery embolization. In groups B and C, gradient decreased from 15 mmHg to 8 mmHg and 16 mmHg to 6 mmHg. All patients except for one in group A and two in C had greater than 50% reduction in the number of paracenteses in 3 months. Any postprocedural encephalopathy incidence was 62%, 50%, 83% in groups A, B, and C, respectively. Overall, 20% of subjects with 10 mm TIPS required TIPS reduction/closure compared to 7% of subjects with 8 mm TIPS. CONCLUSION: We found that 8 mm diameter TIPS provided similar ascites control compared to 10 mm TIPS regardless of splenic embolization. While more patients with 10 mm TIPS required reduction/closure for severe encephalopathy, the study was underpowered for definitive assessment. Splenic embolization might have the potential to further decrease portosystemic gradient and ascites as an alternative to dilation of TIPS to 10 mm minimizing the risk of encephalopathy, but larger studies are warranted.
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Authors | Nathan E Frenk, Teodora Bochnakova, Suvranu Ganguli, Nathaniel Mercaldo, Andrew S Allegretti, Daniel S Pratt, Kei Yamada |
Journal | Diagnostic and interventional radiology (Ankara, Turkey)
(Diagn Interv Radiol)
Vol. 27
Issue 2
Pg. 232-237
(Mar 2021)
ISSN: 1305-3612 [Electronic] Turkey |
PMID | 33517259
(Publication Type: Journal Article)
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Topics |
- Ascites
(etiology, therapy)
- Humans
- Liver Cirrhosis
(complications)
- Portasystemic Shunt, Transjugular Intrahepatic
- Retrospective Studies
- Splenic Artery
(diagnostic imaging)
- Treatment Outcome
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