Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) created using covered stents of different diameters: A systematic review and meta-analysis

Huang, Zongzhang; Yao, Qigu; Zhu, Jianping; He, Ying; Chen, Yanghao; Wu, Feng

doi:10.1016/j.diii.2020.11.004

Cited by 20 publications

(16 citation statements)

References 44 publications

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“…As for variceal rebleeding, our study showed that the cumulative rate was 3.4% at 1 year, 8.9% at 2 years and 17.3% at 3 years ( Table 3 ), which was comparable to the reported rates ranged from 0% to 23% at 1 year and 0% to 27% at 3 years [ 24 28 ] in western studies, and 0% at 1 year and 9% at 2 years in Chinese studies [ 9 27 ]. This may be explained by the fact that portal pressure gradient is the dominant factor determine variceal bleeding [ 32 ], and TIPS can effectively reduce portal hypertension irrespective of patient selection. Our study demonstrated that baseline ALT, etiology and stent connection were significantly associated with variceal rebleeding at univarivate analysis, while none was at multivariate analysis, probably due to its small sample size that was insufficient to identify any predictor.…”

Section: Discussionmentioning

confidence: 99%

Elective Transjugular Intrahepatic Portosystemic Shunt Using Viatorr Stent-Grafts: A Single-Center Experience from China

Wan

et al. 2022

Journal of the Belgian Society of Radiology

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Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established approach for the management of variceal bleeding, refractory ascites, hepatic hydrothorax, and preoperative treatment of portal hypertension prior to major abdominal surgery in patients with compensated cirrhosis, and so on. This study aimed to investigate the safety and long-term efficacy of TIPS implantation using Viatorr TIPS stent-grafts. Material and Methods: A cohort of 59 patients undergoing TIPS placement using Viatorr TIPS stent-grafts were included, and the periprocedural events, and long-term mortality, shunt dysfunction, variceal rebleeding and incidence of hepatic encephalopathy (HE) were analyzed. Results: The technical success rate was 100%. The median portosystemic pressure gradient was reduced from 21 mmHg (interquatile range: 19–25) to 13 mmHg (interquatile range: 10–16) before and after TIPS, leading to a hemodynamic success rate of 72.9%. The cumulative rate of overall mortality was 34.2% at five years, and direct bilirubin (hazard ratio [HR] = 1.336, 95% confidence interval [CI]: 1.050–1.700, P = 0.018) and post-TIPS right atrial pressure (HR = 1.238, 95% CI: 1.015–1.510, P = 0.035) were independent predictors for mortality. The cumulative rates of shunt dysfunction and variceal rebleeding were 11.0% and 28.3% at five years, respectively, and portal venous pressure gradient (HR = 2.572, 95% CI: 1.094–6.047, P = 0.030) was the only independent predictor for shunt dysfunction. The cumulative four-year HE-free rate was 48.6%. No severe adverse event was noted during TIPS procedures. Conclusion: Elective TIPS implantation using Viatorr TIPS stent-grafts is generally safe, and the long-term efficacy is favorable for the treatment of cirrhotic patients with recurrent variceal bleeding or refractory ascites.

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Section: Discussionmentioning

confidence: 99%

Elective Transjugular Intrahepatic Portosystemic Shunt Using Viatorr Stent-Grafts: A Single-Center Experience from China

Wan

et al. 2022

Journal of the Belgian Society of Radiology

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“…[ 33 ] Post-TIPS HE is triggered by hepatocellular failure as well as portosystemic shunting and has been presented in 18% to 45% cirrhosis patients, and the incidence of refractory HE post-TIPS range between 3% and 8%, [ 34 ] which confirmed that a strong correlation exists between liver hemodynamics and the post-TIPS HE incidence. [ 35 ] Huang et al [ 36 ] reported that the cumulative HE rates were obviously lower in smaller stents. And Wang et al [ 26 ] showed that were spontaneous overt HE caused by the liver functions.…”

Section: Discussionmentioning

confidence: 99%

Anticoagulation after transjugular intrahepatic portosystemic shunt for portal hypertension: A systematic review and meta analysis

et al. 2022

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Background: Transjugular intrahepatic portosystemic shunt (TIPS) is widely applied to decrease portal hypertension. Because of the lack of strong evidence, it is controversial whether anticoagulation should be performed after TIPS. This meta-analysis aimed to assess the safety and efficacy of anticoagulation for patients with portal hypertension following TIPS. Methods: Studies making comparisons between combination treatment and TIPS alone were searched in China National Knowledge Infrastructure, Cochrane Library, PubMed, the Wan Fang electronic databases, and EMBASE, delivered between the earliest accessible date and September 4, 2021. The RevMan version 5.3 was applied to conduct all statistical analyses. I 2 index statistic was used to assess heterogeneity. Results: Five eligible studies were selected, and total 707 patients were enrolled. According to the meta-analysis, compared to TIPS alone, TIPS + anticoagulation led to much lower incidence of portal vein thrombosis (PVT; odds ratio [OR] = 0.39, 95% confidence interval [CI] 0.18–0.84, P = .02) as well as low heterogeneity ( P = 0.36, I 2 = 3%). Other index like the stent dysfunction rate (OR = 1.27, 95% CI 0.71–2.77, P = .42), bleeding rate (OR = 1.27, 95% CI 0.71–2.77, P = .42), and incidence of hepatic encephalopathy (OR = 0.87, 95% CI 0.56–1.36, P = .55) showed no statistical significance. Conclusions: In certain patients with portal hypertension, anticoagulation following TIPS may not be required. However, for patients who do not have a PVT before TIPS, post-TIPS anticoagulation can decrease the incidence of PVT. Nonetheless, further research is still required.

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“…A recent meta-analysis of 5 studies concluded that patients treated with 8-mm covered stents have a higher 1-year and 3-year overall survival, a lower rate of HE, and no difference in rebleeding rate, compared to those treated with 10-mm stents. 79 The study by Praktiknjo et al. 80 reported improved 1-year survival and a reduced rate of shunt-related complications in patients treated with underdilated controlled expansion stent grafts, which maintain a stable 8-mm expansion, compared to underdilated VIATORR® TIPS stent grafts.…”

Section: Transjugular Intrahepatic Portosystemic Shuntmentioning

confidence: 99%

Imaging-guided interventions modulating portal venous flow: Evidence and controversies

et al. 2022

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Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) created using covered stents of different diameters: A systematic review and meta-analysis

Cited by 20 publications

References 44 publications

Elective Transjugular Intrahepatic Portosystemic Shunt Using Viatorr Stent-Grafts: A Single-Center Experience from China

Elective Transjugular Intrahepatic Portosystemic Shunt Using Viatorr Stent-Grafts: A Single-Center Experience from China

Anticoagulation after transjugular intrahepatic portosystemic shunt for portal hypertension: A systematic review and meta analysis

Imaging-guided interventions modulating portal venous flow: Evidence and controversies

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