An Approach to Endovascular and Percutaneous Management of Transjugular Intrahepatic Portosystemic Shunt (TIPS) Dysfunction: A Pictorial Essay and Clinical Practice Algorithm

Pereira, Keith; Baker, Reginald; Salsamendi, Jason; Doshi, Mehul; Kably, I.; Bhatia, Shivank

doi:10.1007/s00270-015-1247-4

Cited by 10 publications

(8 citation statements)

References 51 publications

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“…Fewer reintervention and rebleeding episodes were reported for studies where patients, as in the present study, had regular ultrasound monitoring. 23 …”

Section: Discussionmentioning

confidence: 99%

TIPS vs. endoscopic treatment for prevention of recurrent variceal bleeding: a long-term follow-up of 126 patients

Korsic

Štabuc

Skok

et al. 2021

Radiology and Oncology

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Background Recurrent bleeding from gastroesophageal varices is the most common life-threatening complication of portal hypertension. According to guidelines, transjugular intrahepatic portosystemic shunt (TIPS) should not be used as a first-line treatment and should be limited to those bleedings which are refractory to pharmacologic and endoscopic treatment (ET). To our knowledge, long-term studies evaluating the role of elective TIPS in comparison to ET in patients with recurrent variceal bleeding episodes are rare. Patients and methods This study was designed as a retrospective single-institution analysis of 70 patients treated with TIPS and 56 with ET. Patients were followed-up from inclusion in the study until death, liver transplantation, the last follow-up observation or until the end of our study. Results Recurrent variceal bleeding was significantly more frequent in ET group compared to patients TIPS group (66.1% vs. 21.4%, p < 0.001; χ2-test). The incidence of death secondary to recurrent bleeding was higher in the ET group (28.6% vs. 10%). Cumulative survival after 1 year, 2 years and 5 years in TIPS group compared to ET group was 85% vs. 83%, 73% vs. 67% and 41% vs. 35%, respectively. The main cause of death in patients with cumulative survival more than 2 years was liver failure. Median observation time was 47 months (range; 2–194 months) in the TIPS group and 40 months (range; 1–168 months) in the ET group. Conclusions In present study TIPS was more effective in the prevention of recurrent variceal bleeding and had lower mortality due to recurrent variceal bleeding compared to ET.

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“…Fewer reintervention and rebleeding episodes were reported for studies where patients, as in the present study, had regular ultrasound monitoring. 23 …”

Section: Discussionmentioning

confidence: 99%

TIPS vs. endoscopic treatment for prevention of recurrent variceal bleeding: a long-term follow-up of 126 patients

Korsic

Štabuc

Skok

et al. 2021

Radiology and Oncology

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“…The widespread adoption of PTFE‐covered stents has greatly improved long‐term TIPS patency rates compared to traditional bare metal stents . However, TIPS dysfunction remains the most significant long‐term complication of the procedure . Compared to cirrhotic patients, idiopathic BCS patients (∼40–50% MPN prevalence) have a higher incidence of TIPS dysfunction (42 vs. 13%), presumably due to the systemic hypercoaguable state of MPN .…”

Section: Discussionmentioning

confidence: 99%

Multicenter analysis of the use of transjugular intrahepatic portosystemic shunt for management of MPN‐associated portal hypertension

et al. 2017

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BCR-ABL1-negative myeloproliferative neoplasms (MPNs) are clonal stem cell disorders defined by proliferation of one or more myeloid lineages, and carry an increased risk of vascular events and progression to myelofibrosis and leukemia. Portal hypertension (pHTN) occurs in 7–18% of MPN patients via both thrombotic and nonthrombotic mechanisms and portends a poor prognosis. Transjugular intrahepatic portosystemic shunt (TIPS) has been used in the management of MPN-associated pHTN; however, data on long-term outcomes of TIPS in this setting is limited and the optimal management of medically refractory MPN-associated pHTN is not known. In order to assess the efficacy and long-term outcomes of TIPS in MPN-associated pHTN, we performed a retrospective analysis of 29 MPN patients who underwent TIPS at three academic medical centers between 1997 and 2016. The majority of patients experienced complete clinical resolution of pHTN and its clinical sequelae following TIPS. One, two, three, and four-year overall survival post-TIPS was 96.4%, 92.3%, 84.6%, and 71.4%, respectively. However, despite therapeutic anticoagulation, in-stent thrombosis occurred in 31.0% of patients after TIPS, necessitating additional interventions. In conclusion, TIPS can be an effective intervention for MPN-associated pHTN regardless of etiology. However, TIPS thrombosis is a frequent complication in the MPN population and indefinite anticoagulation post-TIPS should be considered.

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“…A standardized TIPS technique has been detailed described previously [15][16][17][18]. After the catheterization of the right or middle hepatic vein was performed through the right internal jugular vein with a transjugular liver access set (RUPS-100; Cook Inc.), a pressure measurement was obtained.…”

Section: Tips Proceduresmentioning

confidence: 99%

A New Choice for the Use of the Stents for Transjugular Intrahepatic Portosystemic Shunt Creation: Viabahn ePTFE covered stent/bare metal stent combination

Liu

Meng

Zhou

et al. 2020

Preprint

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Background Compare the clinical outcome of structure and function between insertion of transjugular intrahepatic portosystemic shunt (TIPS) created with the Viabahn ePTFE covered stent/bare metal stent (BMS) combination and Fluency ePTFE covered stent/BMS combination. Methods 101 consecutive patients undergone TIPS procedure from February 2016 to August 2018 in our center were analyzed retrospectively, 64 subjects were enrolled in Viabahn group and 37 were Fluency group. We caculated the TIPS geometry characteristics and evaluated the related occurrence of shunt dysfunction, survival, overt hepatic encephalopathy (OHE) and variceal rebleeding. Results The technical success rate was 100%. After TIPS insertion, the rate of shunt dysfunction during the first 3 months was significantly different between Viabahn group and Fluency group, which were respectively 1.6% and 13.5% (p = 0.024). And multivariate analysis indicated that the angle of portalvenous inflow (α) (HR = 1.060, 95%CI = 1.009–1.112, p = 0.020) was the only predictor of shunt dysfunction. Besides, after 3 months following TIPS insertion, the α angle distinctly increased from 20.9°±14.3° to 26.9°±20.1° (p = 0.005) in Fluency group but stayed unchanged in Viabahn group (from 21.9°±15.1° to 22.9°±17.6°, p = 0.798). Conclusions The occurence of shunt dysfunction was related to the angle of portalvenous inflow (α), because of the slighter effect on α angle, after TIPS inplanation, Viabahn ePTFE covered stent/BMS combination was more stable in structure and promised higher short-term stent patency compared to Fluency ePTFE covered stent/BMS combination.

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An Approach to Endovascular and Percutaneous Management of Transjugular Intrahepatic Portosystemic Shunt (TIPS) Dysfunction: A Pictorial Essay and Clinical Practice Algorithm

Cited by 10 publications

References 51 publications

TIPS vs. endoscopic treatment for prevention of recurrent variceal bleeding: a long-term follow-up of 126 patients

TIPS vs. endoscopic treatment for prevention of recurrent variceal bleeding: a long-term follow-up of 126 patients

Multicenter analysis of the use of transjugular intrahepatic portosystemic shunt for management of MPN‐associated portal hypertension

A New Choice for the Use of the Stents for Transjugular Intrahepatic Portosystemic Shunt Creation: Viabahn ePTFE covered stent/bare metal stent combination

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