Transjugular Intrahepatic Portosystemic Shunt Creation with Modified Portal Vein Access Site may Decrease Significant Hepatic Encephalopathy: single centre outcomes-Reference-Cited by-同舟云学术

Transjugular Intrahepatic Portosystemic Shunt Creation with Modified Portal Vein Access Site may Decrease Significant Hepatic Encephalopathy: single centre outcomes

Published:2023-08-25 Issue: Volume: Page:
ISSN:
Container-title:
language:
Short-container-title:

Author:

Li Lei¹,Zhao Rui²,Kerrigan Timothy³,Wang Haiping¹,Jahangiri Younes³,Wang Wenhui¹,Mao Xiaorong¹,Farsad Khashayar³

Affiliation:

1. The First Hospital of Lanzhou University

2. The Second Hospital of Lanzhou University

3. Oregon Health and Science University

Abstract

Abstract Background We aimed to assess whether TIPS creation via peripheral right portal vein access (P-RPV), which was considered the classic portal vein access site in TIPS creation, was associated with more severity of post-TIPS HE compared to the other portal vein access (O-PV) which was named the modified portal vein access site. Methods: This was an IRB-approved single-institution retrospective study. Consecutive patients with cirrhosis who underwent technically successful TIPS creation were reviewed. Patients were assigned to two groups: P-RPV group and O-PV group. The primary outcome was a clinically significant change in hepatic encephalopathy (Δ HE). Secondary outcomes included survival, stent patency, de novo HE, overt HE (OHE, grades 2–4), rebleeding and ascites control. Predictors of Δ HE and overall survival were identified using Cox regression models. Results: 328 patients were reviewed, and 230 patients were assigned to the P-RPV group (n = 66) or the O-PV group (n = 164). The incidence of Δ HE was 11 (17%), 14 (21%), 14 (21%) and 15 (23%) patients in the P-RPV group and 11 (7%), 13 (8%), 15 (9%) and 15 (9%) patients in the O-PV group at 30 days (p = 0.02), 90 days (p = 0.005), 180 days (p = 0.01) and 365 days (p = 0.006), respectively. HCV infection (HR, 2.21; 95% CI 1.12–4.38; p = 0.02) and P-RPV shunt location (HR, 2.42; 95%CI 1.19–4.93; p = 0.01) were independently associated with Δ HE after TIPS. Our results did not show an association between survival and HE before TIPS (HR, 1.29; 95% CI 0.89–1.87; p = 0.17). Conclusion: Δ HE was observed in patients with TIPS created from P-RPV compared to O-PV. The modified portal vein access site may reduce the incidence of Δ HE during clinical management.

Publisher

Research Square Platform LLC

Reference32 articles.

1. I. I. Faculty Baveno. "Baveno Vii - Renewing Consensus in Portal Hypertension;Franchis R;J Hepatol,2022

2. Garcia-Tsao, G., J. G. Abraldes, A. Berzigotti, and J. Bosch. "Portal Hypertensive Bleeding in Cirrhosis: Risk Stratification, Diagnosis, and Management: 2016 Practice Guidance by the American Association for the Study of Liver Diseases." Hepatology 65, no. 1 (2017): 310 – 35.

3. Tripathi, D., A. J. Stanley, P. C. Hayes, D. Patch, C. Millson, H. Mehrzad, A. Austin, J. W. Ferguson, S. P. Olliff, M. Hudson, J. M. Christie, Services Clinical, and Gastroenterology Standards Committee of the British Society of. "U.K. Guidelines on the Management of Variceal Haemorrhage in Cirrhotic Patients." Gut 64, no. 11 (2015): 1680 – 704.

4. "Early Use of Tips in Patients with Cirrhosis and Variceal Bleeding.";Garcia-Pagan JC;N Engl J Med,2010

5. Nicoară-Farcău, O, G Han, M Rudler, D Angrisani, A Monescillo, F Torres, G Casanovas, J Bosch, Y Lv, D Thabut, D Fan, V Hernández-Gea, JC García-Pagán, C Bureau, JG Abraldes, F Nevens, K Caca, W Laleman, B Appenrodt, A Luca, JP Vinel, J Mössner, M Di Pascoli, A Zipprich, T Sauerbruch, F Martinez-Lagares, L Ruiz-Del-Arbol, A Sierra, C Guevara, E Jimenez, JM Marrero, E Buceta, J Sanchez, A Castellot, M Penate, A Cruz, E Pena, B Procopet, Á Giráldez, L Amitrano, C Villanueva, L Ibañez-Samaniego, G Silva-Junior, J Martinez, J Genescà, J Trebicka, E Llop, JM Palazon, J Castellote, S Rodrigues, LL Gluud, CN Ferreira, R Barcelo, N Cañete, M Rodríguez, A Ferlitsch, JL Mundi, H Gronbaek, M Hernández-Guerra, R Sassatelli, A Dell'Era, M Senzolo, M Romero-Gómez, M Casas, H Masnou, M Primignani, A Krag, JL Calleja, C Jansen, MA Robic, I Conejo, MV Catalina, A Albillos, E Alvarado, MA Guardascione, M Tanțău, L Zuo, X Zhu, J Zhao, H Xue, Z Jiang, Y Zhuge, C Zhang, J Sun, P Ding, W Ren, Y Li, K Zhang, W Zhang, C He, J Zhong, Q Peng, F Ma, J Luo, M Zhang, G Wang, M Sun, J Dong, W Bai, W Guo, Q Wang, X Yuan, Z Wang, T Yu, B Luo, X Li, J Yuan, N Han, Y Zhu, J Niu, K Li, Z Yin, Y Nie, P Fischer, H Ștefănescu, A Pop, SB Laursen, F Turon, A Baiges, J Ferrusquía-Acosta, M Magaz, E Cerda, L Tellez, G Allegretti, G Macedo, D Haldrup, P Santos, M Moura, D Reis, L Meireles, P Sousa, P Alexandrino, C Navascues, S Augustin, V La Mura, R Bañares, R Diaz, ML Gómez, and C Ripoll. "Effects of Early Placement of Transjugular Portosystemic Shunts in Patients with High-Risk Acute Variceal Bleeding: A Meta-Analysis of Individual Patient Data." Gastroenterology (2020).