Transjugular intrahepatic portosystemic shunt reduces hospital care burden in patients with decompensated cirrhosis (original) (raw)
Related papers
2014
Patients with Child-Pugh class C or class B cirrhosis and persistent bleeding at endoscopy are at high risk for treatment failure and a poor prognosis. This study evaluated the early use of a transjugular intra hepatic portosystemic shunt (TIPS) in such patients. Methods Objective: The study was conducted to determine whether early treatment with extended polytetrafluoro ethylene (e-PTFE) can improve outcomes in patients who have cirrhosis and acute variceal bleeding and who are at high risk for treatment failure and death. Design: The study was a randomized clinical trial. Setting: The study was conducted at nine European centers. Subjects: Eligible patients had cirrhosis with acute esophageal variceal bleeding. Patients had Child-Pugh class C disease (a score of 10 to 13) or class B disease (a score of 7 to 9) but with active bleeding at diagnostic endoscopy. Interventions: Endoscopic band ligation (EBL) or endoscopic injection sclerotherapy was applied at the time of diagnostic e...
La Radiologia …, 2009
Purpose. The authors present a retrospective analysis of a large series of patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement. Materials and methods. Between March 1992 and December 2006, 658 patients were referred to our centre for TIPS placement. Indications for the procedure were digestive tract bleeding (52.8%), refractory ascites (35.3%), preservation of portal vein patency prior to liver transplantation (3.0%) and thrombosis of the suprahepatic veins (2.3%). Other indications (6.6%) included pleural ascites, portal thrombosis and hepatorenal and hepatopulmonary syndromes. All patients were evaluated with colour Doppler ultrasonography and in a few cases with computed tomography. The portal system was punctured under sonographic guidance. Wallstent, Palmaz and Nitinol thermosensitive stents were used. Embolisation of persistent varices was performed in 6.8% of cases. Results. Technical success was 98.9%. During a 1,500-day follow-up, the cumulative incidence of stent revision was 25.7% (Nitinol), 32.9% (Wallstent) and 1.8% (Palmaz). Mortality rates were 31.1%, 38.5% and 56.4%, respectively. The technical complications included six cases of heart failure, six of haematobilia, three of stent migration, two of intrahepatic haematoma and one of haemoperitoneum. Eight patients with severe portosystemic encephalopathy (PSE) were treated with a reduction stent. Riassunto Obiettivo. Gli autori presentano un'analisi retrospettiva di un'ampia casistica di pazienti sottoposti a TIPS. Materiali e metodi. Sono giunti al nostro centro per la TIPS 658 pazienti tra il marzo 1992 e il dicembre 2006. Le indicazioni alla procedura erano: sanguinamento digestivo (52,8%), ascite refrattaria (35,3%), "tutela" della pervietà portale pre-trapianto epatico (3,0%), trombosi delle vene sovraepatiche (2,3%). Altre indicazioni (6,6%) erano ascite pleurica, trombosi portale, sindrome epato-renale ed epato-polmonare. I pazienti sono stati studiati con ecocolor doppler, raramente con tomografia computerizzata; la puntura portale è stata ecoguidata. Sono stati impiegati stent Palmaz, Wallstent e termoespandibili. Nel 6,8% dei casi sono state embolizzate varici persistenti. Risultati. Il successo tecnico è stato del 98,9%. Durante un follow-up di 1500 giorni, l'incidenza cumulativa di reintervento sugli stent è stata del 25,7% (Nitinol), 32,9% (Wallstent) e 1,8% (Palmaz); la mortalità è stata rispettivamente 31,1%, 38,5% e 56,4%. Le complicanze tecniche sono state: 6 insufficienze cardiache, 6 emobilie, 3 migrazioni di stent, 2 ematomi intraepatici ed 1 emoperitoneo. Otto pazienti con encefalopatia portosistemica (PSE) grave sono stati trattati con stent riduttore. Conclusioni. La TIPS è sicura ed efficace, può rappresentare un ponte all'OLT. L'ecografia ha un ruolo fondamentale nello studio preliminare, durante la puntura
Gut, 1996
Background-Transjugular intrahepatic portosystemic stent shunts (TIPSS) are increasingly being used to manage the complications of portal hypertension. This study reports on the follow up on 130 patients who have undergone TIPSS. Patients and Methods-One hundred and thirty patients (81 male), mean (SD) age 54.7 (12.5) years underwent TIPSS. The majority (64.6%) had alcoholic cirrhosis and 53.2% had Childs C disease. Indications were: variceal haemorrhage (76.2%), refractory ascites (13.1%), portal hypertensive gastropathy (4.6%), others (6.1%). Shunt function was assessed by Doppler ultrasonography and two then six monthly portography and mean follow up for survivors was 18-0 months (range 2-43.5).
Journal of Clinical Gastroenterology, 2004
Background: Pleural effusions(PE) complicate cirrhosis in ~5% of patients. Identification of cause and related complications is imperative. Unlike refractory ascites, large-scale studies on interventions for refractory PE are limited. Methods: Consecutive hospitalized cirrhotics having PE were retrospectively analyzed. None had liver transplantation (LT) within 6-month follow-up. We determined safety, efficacy and mortality predictors for PE managed with standard medical treatment(SMT), thoracentesis, catheter drainage and TIPS. Results: Of 1149 cirrhotics with PE(mean Child-Pugh 10.6 ±1.8 and MELD 21.2 ±7.4), 82.6% had hepatic hydrothorax(HH) and 12.3% were suspected tubercular PE(TBPE). Despite comparable HVPG and MELD scores, patients with HH developed more AKI, encephalopathy and septic shock (all P<0.01) on follow up. Among HH, 73.5% were symptomatic, 53.2% isolated right-sided PE and 21.3% had SBE. Presence of SBP[Odd's ratio,OR:4.5] and catheter drainage[OR:2.1] were independent predictors for SBE. In 70.3% of admissions, HH responded to SMT alone, 12.9% required thoracentesis and 11.5% underwent catheter drainage. 51 patients were selected for TIPS [lower mean CTP 9.9±1.6 and MELD score 18.7±5.4]. Despite reduction in pressure gradient from 23.1±3.8 mm Hg to 7.2±2.5 mm Hg, 25 patients had partial response, 10 had complete HH resolution. Major post-TIPS complications were portosystemic encephalopathy(8 patients, 6 resolved) and ischemic hepatitis(4 patients, 2 resolved). Overall, 35.9% patients with HH had 6-month mortality and independent predictors were MELD >25, SBP and septic shock. Conclusion: Refractory PE in cirrhosis requiring interventions including TIPS has poor outcome. Role of hemodynamics in predicting post-TIPS response and complications is limited. Early referral for LT is imperative.
Complications following transjugular intrahepatic portosystemic shunt: a retrospective analysis
Transplantation Proceedings, 2004
Transjugular intrahepatic portosystemic shunt (TIPS) has been the therapeutic option for severe decompensation of chronic liver disease and as a bridge to liver transplantation. The aim of this study was to analyze the complications of this procedure. The records of 47 patients (39 men) of mean age 48 years underwent TIPS procedures from 1998 to 2003 were reviewed. Forty-one patients received 45 successful TIPS; it failed in six patients. Improvement was observed in 20 of 28 patients with upper gastrointestinal bleeding (71%); 9 of 11 with ascites (82%); and 5 of 8 with impaired renal function (62%). The Child-Pugh scores improved in 6 of the 47 patients (13%). Transplantation was performed in 11 patients (23%). The complications were: encephalopathy (49%); infection (19%); renal failure (17%); TIPS migration to the portal vein (4%) and to the right atrium (4%). Mortality was 32% (15/47) over 3 months. Eight patients developed active bleeding during TIPS installation requiring mechanical ventilation and intensive care, and died within the first week. Other causes of death were sepsis (n ϭ 2), liver failure (n ϭ 1), accidental puncture of the Glisson's capsule leading to intra-abdominal bleeding (n ϭ 1) and refractory upper gastrointestinal bleeding (n ϭ 3). The latter four patients had TIPS placement failure. In conclusion, TIPS produced clinical improvement among 51% of patients with complications in 49%. The main complications were encephalopathy (49%), infection (19%), and renal failure (17%). The 3-month mortality rate after TIPS placement was 32%.