Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunts

Haskal, Ziv J.; Martin, Louis G.; Cardella, John F.; Cole, Patricia E.; Drooz, Alain; McCowan, Timothy C.; Meranze, Steven G.; Neithamer, Calvin D.; Oglevie, Steven B.; Roberts, Adrian; Sacks, David; Silverstein, Mark I.; Swan, Timothy L.; Towbin, Richard B.; Lewis, Curtis A.

doi:10.1016/s1051-0443(07)61817-x

Cited by 82 publications

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“…A transjugular intrahepatic portosystemic shunt (TIPS) is an important therapeutic option in managing the complications of portal hypertension, such as variceal bleeding and refractory ascites (15). Some patients who have undergone a TIPS procedure for the treatment of complications related to portal hypertension are later found to have HCC and require therapy for the cancer.…”

mentioning

confidence: 99%

Hepatotoxicity after Transarterial Chemoembolization and Transjugular Intrahepatic Portosystemic Shunt: Do Two Rights Make a Wrong?

Kohi

Fidelman

Naeger

et al. 2013

Journal of Vascular and Interventional Radiology

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Purpose: To compare the rates of hepatotoxicity after transarterial chemoembolization for hepatocellular carcinoma (HCC) in patients with and without a transjugular intrahepatic portosystemic shunt (TIPS) who were stratified into comparable risk groups. Materials and Methods:A retrospective review of patients with HCC who were treated with transarterial chemoembolization between January 2005 and December 2009 was performed. Of 158 patients with comparable model for end-stage liver disease (MELD) scores, 10 had a patent TIPS. Hepatobiliary severe adverse events (SAEs) occurring after transarterial chemoembolization were documented. In addition, 1-year survival and liver transplantation rate after transarterial chemoembolization were calculated in each group. Results:The incidence of hepatobiliary SAEs after transarterial chemoembolization was nearly two times higher in patients with a TIPS (70%) than in patients without a TIPS (36%; P ¼ .046). The liver transplantation rate 1 year after transarterial chemoembolization was 2.5 times higher in patients with a TIPS (80%) than in patients without a TIPS (32%; P ¼ .004). There was no significant difference in 1-year survival between the two groups after transarterial chemoembolization. Conclusions:Patients with HCC and a patent TIPS are more likely to develop significant hepatotoxicity after transarterial chemoembolization than comparable patients without a TIPS in place.

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confidence: 99%

Hepatotoxicity after Transarterial Chemoembolization and Transjugular Intrahepatic Portosystemic Shunt: Do Two Rights Make a Wrong?

Kohi

Fidelman

Naeger

et al. 2013

Journal of Vascular and Interventional Radiology

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“…Relative contraindications include polycystic liver disease and extensive primary or secondary hepatic malignancy. 9 Exclusion of TIPS depends on the degree of hepatic involvement and the perceived increase in the risk of technical complications. Shunts also have also been created successfully in these latter situations in which hepatic neoplasms 18 and cysts 19,20 lie within the proposed shunt path.…”

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confidence: 99%

Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting

Wallace

Madoff

Ahrar

et al. 2004

Cancer

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BACKGROUNDTransjugular intrahepatic portosystemic shunt (TIPS) placement has emerged as an effective and minimally invasive method of treating portal hypertension and its associated complications. To the authors' knowledge there is limited documentation of its use for percutaneous shunting in patients with hepatic and extrahepatic malignancies. The current study reports the authors' experience with TIPS in the oncology setting.METHODSThirty‐eight patients with cancer underwent TIPS procedures. Nineteen patients had a history of hepatic malignancy. All medical records and imaging studies were reviewed retrospectively. The indication for TIPS, the presence of malignancy, procedural details, complications, survival, and treatment success were assessed.RESULTSPrimary technical success was accomplished in 37 of 38 patients (97%) without technical procedure‐related complications. Hepatic encephalopathy occurred in 15 of 34 patients (44%), with 3 patients requiring shunt reduction. Premature shunt occlusion (< 30 days) occurred in 3 patients (8%). Recurrent hemorrhage occurred in 1 of 19 patients (5%), and ascites and hepatic hydrothorax resolved or improved subjectively in 9 of 12 patients (75%). Shunts traversed malignancy in 9 patients, and varying degrees of portal compromise were encountered in 12 patients (32%). The overall 30‐day and 90‐day survival rates were 84% and 60%, respectively. There was a statistically significant difference in 90‐day survival rates for patients who had ascites and hepatic hydrothorax indications (27%) compared with patients who had variceal and portal gastropathy indications (84%; P = 0.0075). In addition, the 90‐day survival rate was significantly lower in patients who had primary hepatic malignancies (36%) compared with the remainder of the study population (74%; P = 0.0077), and it was significantly lower in patients who had model for end‐stage liver disease (MELD) scores ≥ 12 (P = 0.0020).CONCLUSIONSTIPS was performed safely for patients with cancer without increasing rates of procedure‐related complications. However, some patients subgroups, such at those with malignancy and ascites, primary hepatic malignancy, or MELD scores ≥ 12, had the lowest 90‐day survival rates. Cancer 2004. © 2004 American Cancer Society.

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“…TIPS creation was performed in all patients as previously described [1][2][3][4]15 and included transjugular catheterization of the portal vein. The portal vein was punctured, pressures measured in its main stem and the inferior vena cava above the hepatic veins, the needle track dilated using a balloon catheter, and one to 3 stents (Wallstent; Boston Scientiˆc, Natick, MA, USA) placed.…”

Section: Tipsmentioning

confidence: 99%

“…Outcomes were reviewed on patient charts; technical di‹culty was recorded when TIPS creation could not be completed during one procedural session; and major complications 15 during TIPS procedures were recorded. Hemodynamic success was deˆned as a portosystemic pressure gradient equal to 12 mmHg or less after TIPS.…”

Section: Tipsmentioning

confidence: 99%

“…Hemodynamic success was deˆned as a portosystemic pressure gradient equal to 12 mmHg or less after TIPS. 15 Therapeutic success was deˆned as immediate homeostasis for variceal or gastrointestinal mucosal bleeding or reduced frequency of paracentesis for ascites or hydrothorax. Early mortality was evaluated by patient death within 30 days after TIPS and recorded onset or worsening of hepatic encephalopathy after TIPS.…”

Section: Tipsmentioning

confidence: 99%

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MR Evaluation of Portal Hypertensive Collateral Shunting Vessels for Predicting Outcome after Transjugular Intrahepatic Portosystemic Shunt

Yoshikawa

Mitchell

2011

magn reson med sci

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Purpose: We assessed whether magnetic resonance (MR) imaging evaluation of portosystemic collateral shunts can aid prediction of therapeutic eŠectiveness and complications after creation of a transjugular portosystemic shunt (TIPS), and technical di‹culty during the TIPS procedure.Materials and Methods: We retrospectively reviewed 32 patients (27 men, 5 women; mean age, 56.4 years) who underwent TIPS creation following gadolinium-enhanced MR examination. We measured the diameters of pre-existing portosystemic collateral shunting vessels, added the measurements together to generate a shunting collateral score for each patient, and divided patients into 2 groups by score of 4 or greater or less than 4. We then compared therapeutic eŠectiveness, technical di‹culty and complications of the TIPS procedure, and portal venous (PV) pressure, PV-inferior vena cava (IVC) pressure gradient, and PV diameter between the groups.Results: The patients with a pre-existing large portosystemic shunt showed insigniˆcant trends toward higher technical di‹culty of the shunt procedure and rate of shunt dysfunction. The 2 groups showed no signiˆcant diŠerence in early mortality rate, onset or worsening rate of hepatic encephalopathy after TIPS creation, PV pressure, PV-IVC pressure gradient, or PV diameter.Conclusion: Gadolinium-enhanced MR imaging may help in predicting technical di‹-culty and complications of TIPS.

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Quality Improvement Guidelines for Transjugular Intrahepatic Portosystemic Shunts

Cited by 82 publications

References 0 publications

Hepatotoxicity after Transarterial Chemoembolization and Transjugular Intrahepatic Portosystemic Shunt: Do Two Rights Make a Wrong?

Hepatotoxicity after Transarterial Chemoembolization and Transjugular Intrahepatic Portosystemic Shunt: Do Two Rights Make a Wrong?

Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting

MR Evaluation of Portal Hypertensive Collateral Shunting Vessels for Predicting Outcome after Transjugular Intrahepatic Portosystemic Shunt

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