High Incidence of Hepatic Encephalopathy After Viatorr Controlled Expansion Transjugular Intrahepatic Portosystemic Shunt Creation.

Abstract

BACKGROUND:

The Viatorr Controlled Expansion (VCX) stent-graft was designed to mitigate hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation.

AIMS:

To determine the incidence and degree of HE after VCX TIPS.

METHODS:

Thirty-three patients (M:F 17:16, mean age 58 years, mean MELD score 12) who underwent VCX TIPS between 2018 and 2019 were retrospectively studied. 11/33 (33%) patients had medically controlled pre-TIPS HE. TIPS indications included variceal hemorrhage (n = 12, 30%) and ascites (n = 21, 70%). Measured outcomes were post-TIPS HE (overall, recurrent, de novo) graded using the West Haven system, time-to-HE occurrence, HE-related hospitalization rate, and TIPS reduction rate.

RESULTS:

VCX TIPS were 8 mm in 28/33 (85%) and 10 mm in 5/33 (15%). Mean final portosystemic pressure gradient was 6 mmHg. Cumulative HE incidence post-TIPS was 61% (20/33). 1-, 3-, 6-, and 12-month HE rates were 24%, 30%, 53%, and 61% over 247-day median follow-up. Median time-to-HE was 180 days. HE grades spanned grade 1 (n = 6), grade 2 (n = 8), and grade 3 (n = 6); 9 and 11 cases were recurrent and de novo HE, respectively. Medication non-compliance/infection was implicated in HE in 9/20 (45%) cases. Medical therapy addressed HE in 18/20 (90%) cases; however, HE still resulted in 39 hospitalizations among 13 patients, and median time to first hospitalization was 75 days. Shunt reduction was necessary in 2 (10%) cases of medically refractory HE.

CONCLUSIONS:

The incidence of HE after VCX TIPS is high. Though HE symptoms may be medically controlled, hospitalization rates are high, and shunt reduction may be necessary.

• Authors: Marie-Louise Kloster, Albert Ren, Ketan Y Shah, Murad M Alqadi, James T Bui, Andrew J Lipnik, Matthew M Niemeyer, Charles E Ray, Ron C Gaba
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 66 Issue 11 Pg. 4058-4062 (11 2021) ISSN: 1573-2568 [Electronic] United States
• PMID: 33236314 (Publication Type: Journal Article)
• Copyright: © 2020. Springer Science+Business Media, LLC, part of Springer Nature.

Topics

• Female
• Hepatic Encephalopathy (etiology)
• Humans
• Incidence
• Male
• Middle Aged
• Portasystemic Shunt, Transjugular Intrahepatic (adverse effects, instrumentation)
• Risk Factors
• Stents (adverse effects)
• Treatment Outcome