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.
OBJECTIVE: To report an initial experience using a primary constrained transjugular intrahepatic portosystemic shunt (TIPS) technique for treating cirrhoticpatients 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: Sean R Dariushnia; Ziv J Haskal; Mehran Midia; Louis G Martin; T Gregory Walker; Sanjeeva P Kalva; Timothy W I Clark; Suvranu Ganguli; Venkataramu Krishnamurthy; Cindy K Saiter; Boris Nikolic Journal: J Vasc Interv Radiol Date: 2015-11-21 Impact factor: 3.464
Authors: Ron C Gaba; Patrick M Couture; James T Bui; M Grace Knuttinen; Natasha M Walzer; Eric R Kallwitz; Jamie L Berkes; Scott J Cotler Journal: J Vasc Interv Radiol Date: 2013-01-09 Impact factor: 3.464
Authors: Ahmad Parvinian; Kruti D Shah; Patrick M Couture; Jeet Minocha; M Grace Knuttinen; James T Bui; Ron C Gaba Journal: J Vasc Interv Radiol Date: 2013-05-23 Impact factor: 3.464
Authors: Christophe Bureau; Juan Carlos Garcia Pagan; Gilles Pomier Layrargues; Sophie Metivier; Pablo Bellot; Pierre Perreault; Philippe Otal; Juan-G Abraldes; Jean Marie Peron; Hervé Rousseau; Jaume Bosch; Jean Pierre Vinel Journal: Liver Int Date: 2007-08 Impact factor: 5.828