Recurrent Variceal Bleeding and Shunt Patency: Prospective Randomized Controlled Trial of Transjugular Intrahepatic Portosystemic Shunt Alone or Combined with Coronary Vein Embolization

Chen, Shuang; Li, Xiao; Wei, Bo; Tong, Huan; Zhang, Mingguang; Huang, Zhiyin; Cao, Ji; Tang, Cheng-Wei

doi:10.1148/radiol.13120800

Cited by 84 publications

(70 citation statements)

References 22 publications

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“…Over 30% of patients experience post-TIPS hepatic encephalopathy due to increased levels of circulating ammonia and other metabolites from the gut; 70% of these patients experience hepatic encephalopathy within 3 months after TIPS placement (6). The second major complication is recurrent portal hypertension secondary to development of in-stent stenosis, despite improved patency with the advent of covered stents (7,8). Therefore, comprehensive and longitudinal hemodynamic monitoring of the portal system and the TIPS is needed to monitor stent patency and the fraction of blood flow that is diverted from the liver (9,10).…”

mentioning

confidence: 99%

Longitudinal Monitoring of Hepatic Blood Flow before and after TIPS by Using 4D-Flow MR Imaging

Bannas¹,

Roldán‐Alzate²,

Johnson³

et al. 2016

Radiology

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Purpose To demonstrate the feasibility of four-dimensional (4D)– flow magnetic resonance (MR) imaging for noninvasive longitudinal hemodynamic monitoring of hepatic blood flow before and after transjugular intrahepatic portosystemic shunt (TIPS) placement. Materials and Methods The institutional review board approved this prospective Health Insurance Portability and Accountability Act compliant study with written informed consent. Four-dimensional–flow MR imaging was performed in seven patients with portal hypertension and refractory ascites before and 2 and 12 weeks after TIPS placement by using a time-resolved three-dimensional radial phase-contrast acquisition. Flow and peak velocity measurements were obtained in the superior mesenteric vein (SMV), splenic vein (SV), portal vein (PV), and the TIPS. Flow volumes and peak velocities in each vessel, as well as the ratio of in-stent to PV flow, were compared before and after TIPS placement by using analysis of variance. Results Flow volumes significantly increased in the SMV (0.24 L/ min; 95% confidence interval [CI]: 0.07, 0.41), SV (0.31 L/min; 95% CI: 0.07, 0.54), and PV (0.88 L/min; 95% CI: 0.06, 1.70) after TIPS placement (all P < .05), with no significant difference between the first and second post-TIPS placement acquisitions (all P > .11). Ascites resolved in six of seven patients. In those with resolved ascites, the TIPS-to-PV flow ratio was 0.8 ± 6 0.2 and 0.9 ± 0.2 at the two post-TIPS time points, respectively, while the observed ratios were 4.6 and 4.3 in the patient with refractory ascites at the two post-TIPS time points, respectively. In this patient, 4D-flow MR imaging demonstrated arterio-portal-venous shunting, with draining into the TIPS. Conclusion Four-dimensional–flow MR imaging is feasible for noninvasive longitudinal hemodynamic monitoring of hepatic blood flow before and after TIPS placement.

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mentioning

confidence: 99%

Longitudinal Monitoring of Hepatic Blood Flow before and after TIPS by Using 4D-Flow MR Imaging

Bannas¹,

Roldán‐Alzate²,

Johnson³

et al. 2016

Radiology

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“…Although the benefits of variceal embolization or sclerotherapy are still controversial (11), the geometry of the DIPS did not impact the ability to perform these adjunctive procedures. However, none of the patients underwent periumbilical varix embolization, which could be hindered by a caudally directed extrahepatic portal vein puncture site.…”

Section: Discussionmentioning

confidence: 98%

Emergent Salvage Direct Intrahepatic Portocaval Shunt Procedure for Acute Variceal Hemorrhage

Ward

Techasith

Louie

et al. 2015

Journal of Vascular and Interventional Radiology

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“…At our knowledge, no other studies showed such data. This could be explained by the fact that oesophageal or gastric post-TIPS varices create a competitive flow, leading to more risk of stent thrombosis or stenosis because of lower flow into the TIPS (38,39). Indeed, persistent flow into varices can be responsible for hemodynamic steal from the PV leading to slower flow into the TIPS shunt and potentially higher risk of in-stent thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Persistence of gastric or esophageal varices on final angiography increases transjugular intrahepatic portosystemic shunt revision rate after polytetrafluoroethylene-covered stent shunt creation

Moulin¹,

Chevallier²,

Abdulmalak³

et al. 2018

Quant. Imaging Med. Surg.

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Background: To assess the association between final polytetrafluoroethylene (PTFE)-covered stent transjugular intrahepatic portosystemic shunt (TIPS) angiographic parameters and free shunt revision survey. Results: Mean follow-up was 455 days. Thirteen (19.4%) patients had shunt revision. Significant free shunt revision survey difference was found between post-procedural angiographic persistent varices group and the group without varices (P=0.0001). Shunt revision rate at 3, 12 and 24 months was respectively 13%, 29%, and 39% in the group with varices versus 0%, 2.7% and 2.7% in the group without. No difference was found between groups for angles A, B, C and distance D.Conclusions: Persistence of gastric or esophageal varices on final trans-TIPS angiography increases TIPS revision rate after PTFE-covered stent shunt creation whereas geometric parameters have no influence.

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Recurrent Variceal Bleeding and Shunt Patency: Prospective Randomized Controlled Trial of Transjugular Intrahepatic Portosystemic Shunt Alone or Combined with Coronary Vein Embolization

Abstract: The TIPS+E regimen may reduce the risk of recurrent variceal bleeding during the first 6 months after the TIPS procedure by preventing shunt dysfunction, which may improve liver function and quality of life. © RSNA, 2013.

Cited by 84 publications

References 22 publications

Longitudinal Monitoring of Hepatic Blood Flow before and after TIPS by Using 4D-Flow MR Imaging

Longitudinal Monitoring of Hepatic Blood Flow before and after TIPS by Using 4D-Flow MR Imaging

Emergent Salvage Direct Intrahepatic Portocaval Shunt Procedure for Acute Variceal Hemorrhage

Persistence of gastric or esophageal varices on final angiography increases transjugular intrahepatic portosystemic shunt revision rate after polytetrafluoroethylene-covered stent shunt creation

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