D Bettinger1, M Schultheiss2, T Boettler2, M Muljono2, R Thimme2,3, M Rössle2,3. 1. Department of Medicine II, University Hospital Freiburg, Freiburg, Germany. dominik.bettinger@uniklinik-freiburg.de. 2. Department of Medicine II, University Hospital Freiburg, Freiburg, Germany. 3. PraxisZentrum für Gastroenterologie und Endokrinologie, Freiburg, Germany.
Abstract
BACKGROUND: The implantation of a transjugular intrahepatic portosystemic shunt (TIPSS) is a complex angiographic procedure performed in patients with end-stage liver disease. Numerous case reports and narrative reviews have been published so far; however, studies systematically investigating procedural and shunt-related complications are lacking. AIM: To systematically investigate complications and mortality occurring during the index hospital stay and the early (4-week) period after TIPSS implantation. METHODS: The study includes 389 patients who received a TIPSS implantation between 2004 and 2014. Data were obtained from the clinical records and technical reports of the TIPSS implantation. RESULTS: During the index hospital stay, procedure-related complications occurred in 42 patients (10.8%) with intraperitoneal bleeding in 8 patients (2.1%) and infections in 14 patients (3.6%). Shunt- and disease-related complications consisted of hepatic encephalopathy (1-year incidence 29%), non-procedural infections (8.7%) and acute hepatic decompensation (4.1%). Nine patients (2.3%) died during the index hospital stay from procedure-related (two patients, 0.5%), shunt-related (four patients, 1%) or disease-related causes (three patients, 0.8%). 23 patients (5.9%) died during 4 weeks after TIPSS implantation. The 1-year probability of survival was 67.7% and was negatively associated with severe hepatic encephalopathy and acute hepatic decompensation. CONCLUSIONS: Except hepatic encephalopathy, severe procedure- and shunt-related complications are rare and early mortality is low.
BACKGROUND: The implantation of a transjugular intrahepatic portosystemic shunt (TIPSS) is a complex angiographic procedure performed in patients with end-stage liver disease. Numerous case reports and narrative reviews have been published so far; however, studies systematically investigating procedural and shunt-related complications are lacking. AIM: To systematically investigate complications and mortality occurring during the index hospital stay and the early (4-week) period after TIPSS implantation. METHODS: The study includes 389 patients who received a TIPSS implantation between 2004 and 2014. Data were obtained from the clinical records and technical reports of the TIPSS implantation. RESULTS: During the index hospital stay, procedure-related complications occurred in 42 patients (10.8%) with intraperitoneal bleeding in 8 patients (2.1%) and infections in 14 patients (3.6%). Shunt- and disease-related complications consisted of hepatic encephalopathy (1-year incidence 29%), non-procedural infections (8.7%) and acute hepatic decompensation (4.1%). Nine patients (2.3%) died during the index hospital stay from procedure-related (two patients, 0.5%), shunt-related (four patients, 1%) or disease-related causes (three patients, 0.8%). 23 patients (5.9%) died during 4 weeks after TIPSS implantation. The 1-year probability of survival was 67.7% and was negatively associated with severe hepatic encephalopathy and acute hepatic decompensation. CONCLUSIONS: Except hepatic encephalopathy, severe procedure- and shunt-related complications are rare and early mortality is low.
Authors: Rosalie C Oey; Koos de Wit; Adriaan Moelker; Tugce Atalik; Otto M van Delden; Geert Maleux; Nicole S Erler; R Bart Takkenberg; Robert A de Man; Frederik Nevens; Henk R van Buuren Journal: Aliment Pharmacol Ther Date: 2018-08-22 Impact factor: 8.171
Authors: Lukas Sturm; Michael Praktiknjo; Dominik Bettinger; Jan P Huber; Lara Volkwein; Arthur Schmidt; Rafael Kaeser; Johannes Chang; Christian Jansen; Carsten Meyer; Daniel Thomas; Robert Thimme; Jonel Trebicka; Michael Schultheiß Journal: Hepatol Commun Date: 2021-01-05
Authors: Lukas Sturm; Dominik Bettinger; Max Giesler; Tobias Boettler; Arthur Schmidt; Nico Buettner; Robert Thimme; Michael Schultheiss Journal: United European Gastroenterol J Date: 2018-08-15 Impact factor: 4.623