Rebleeding rates following TIPS for variceal hemorrhage in the Viatorr era: TIPS alone versus TIPS with variceal embolization

Abstract

Purpose To compare rebleeding rates following treatment of variceal hemorrhage with TIPS alone versus TIPS with variceal embolization in the covered stent-graft era. Methods In this retrospective study, 52 patients (M:F 29:23, median age 52 years) with hepatic cirrhosis and variceal hemorrhage underwent TIPS insertion between 2003 and 2008. Median Child-Pugh and MELD scores were 8.5 and 13.5. Generally, 10-mm diameter TIPS were created using covered stent-grafts (Viatorr; W.L. Gore and Associates, Flagstaff, AZ). A total of 37 patients underwent TIPS alone, while 15 patients underwent TIPS with variceal embolization. The rates of rebleeding and survival were compared. Results All TIPS were technically successful. Median portosystemic pressure gradient reductions were 13 versus 11 mmHg in the embolization and non-embolization groups. There were no statistically significant differences in Child-Pugh and MELD score, or portosystemic pressure gradients between each group. A trend toward increased rebleeding was present in the non-embolization group, where 8/37 (21.6%) patients rebled while 1/15 (6.7%) patients in the TIPS with embolization group rebled (P = 0.159) during median follow-up periods of 199 and 252 days (P = 0.374). Rebleeding approached statistical significance among patients with acute hemorrhage, where 8/32 (25%) versus 0/14 (0%) rebled in the non-embolization and embolization groups (P = 0.055). A trend toward increased bleeding-related mortality was seen in the nonembolization group (P = 0.120).Conclusions TIPS alone showed a high incidence of rebleeding in this series, whereas TIPS with variceal embolization resulted in reduced recurrent hemorrhage. The efficacy of embolization during TIPS performed for variceal hemorrhage versus TIPS alone should be further compared with larger prospective randomized trials.

Embolization of percutaneous transhepatic portal venous access tract withN-butyl cyanoacrylate

“…[7][8][9][22][23][24][25] Among these routes, TIPS and percutaneous transhepatic access are the two most commonly used access routes. Compared with the TIPS access, the percutaneous transhepatic access offers direct access to the portal vein along the long axis of the portal vein and allows easier access to the peripheral intrahepatic portal vein branches.…”

“…28,29 Various materials are used for embolization of tracts in the liver parenchyma after portal vein manipulation, including gelatin sponge particles, biological tissue adhesives, coils and vascular plugs. [10][11][12][13][23][24][25] The most commonly used embolic materials for the closure of percutaneous portal vein access tracts are coils and gelatin sponge particles; however, they have their own drawbacks. With the use of gelatin sponge particles, incomplete tract embolization or delayed bleeding may occur owing to its soluble and impermanent nature.…”

Transjugular intrahepatic portosystemic shunt in combination with or without variceal embolization for the prevention of variceal rebleeding: A meta‐analysis

“…Concomitant use of variceal embolization during TIPS procedure is theoretically advocated by previous studies in which percutaneous transhepatic variceal embolization could reduce the recurrence of varices and variceal bleeding . Indeed, several researchers suggested that TIPS in combination with embolotherapy of gastroesophageal collateral vessels could lower the rate of rebleeding in comparison with TIPS alone . However, other researchers found a similar incidence of variceal rebleeding between the two groups .…”

Comprehensive Review of TIPS Technical Complications and How to Avoid Them

“…ing rates after TIPS [37]. Because of the fragile nature of thin-walled varices, catheterization using 5-French systems and embolization with 0.035-inch-diameter coils may occasionally result in catheter-or wire-related vessel trauma and contrast extravasation if operators are too forceful during manipulation of these devices (Fig.…”