Transjugular extrahepatic portosystemic shunt (TEPS) creation in patients with complete occlusion of portal vein: Primary experience in a single medical center

Wang, Linlin; Yao, Peng; Qian, Yun; Liu, Zhenyu; Du, Jingfeng; Yu, Ming-Chih; Feng, Liqiang; Dai, Zhongming; Long, Xu

doi:10.1016/j.clinre.2021.101786

Cited by 2 publications

(1 citation statement)

References 5 publications

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“…Li reported 20 cases of mesocaval portosystemic shunt, exhibiting a 100% success rate and good short-term patency, without severe surgical complications [5]. Another case report of three patients undergoing interventional extrahepatic shunt also revealed good safety outcomess [6].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Precision-Guided Transjugular Extrahepatic Portosystemic Shunt (TEPS) in the Management of Cavernous Transformation of the Portal Vein with Portal Hypertension: A Case Series

Zhang,

Zhu,

Wang

et al. 2023

Preprint

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Background and Aims: Performing a Transjugular intrahepatic portal system shunt (TIPS) in patients with portal vein cavernous transformation (CTPV) poses significant challenges. As an alternative, transjugular extrahepatic portal vein shunt (TEPS) may offer a potential solution for these patients. Nonetheless, the effectiveness and safety of TEPS remain uncertain. This case series study aimed to evaluate the efficacy and safety of TEPS in treating patients with CTPV portal hypertension complications. Methods:The study encompassed a cohort of twenty-two patients diagnosed with CTPV who underwent TEPS procedures.Of these, thirteen patients manifested recurrent hemorrhagic episodes subsequent to conventional therapies, eight patients grappled with recurrent or refractory ascites, and one patient experienced acute bleeding but refused endoscopic treatment. Comprehensive postoperative monitoring was conducted for all patients to rigorously evaluate both the technical and clinical efficacy of the intervention,as well as long-term outcomes. Results:The overall procedural success rate among the 22 patients was 95.5% (21/22).During the TEPS procedure, nine patients were guided by percutaneous splenic access, three patients were guided by percutaneous hepatic access, five patients were guided by transmesenteric vein access from the abdomen, and two patients were guided by catheter marking from the hepatic artery. Additionally, guidance for three patients was facilitated by pre-existing TIPS stents.The postoperative portal pressure gradient following TEPS demonstrated a statistically significant decrease compared to preoperative values (24.95±3.19 mmHg vs. 11.48±1.74 mmHg, P<0.01).Although three patients encountered perioperative complications, their conditions ameliorated following symptomatic treatment, and no procedure-related fatalities occurredDuring a median follow-up period of 14 months, spanning a range of 5 to 39 months, we observed four fatalities. Specifically, one death was attributed to hepatocellular carcinoma, while the remaining three were ascribed to chronic liver failure.During the follow-up period, no instances of shunt dysfunction were observed. Conclusions:Precision-guided TEPS appears to be a safe and efficacious intervention for the management of CTPV.

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Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Precision-Guided Transjugular Extrahepatic Portosystemic Shunt (TEPS) in the Management of Cavernous Transformation of the Portal Vein with Portal Hypertension: A Case Series

Zhang,

Zhu,

Wang

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

Efficacy and safety of precision-guided transjugular extrahepatic portosystemic shunt (TEPS) in the management of cavernous transformation of the portal vein with portal hypertension: a case series

Zhang,

Zhu,

Wang

et al. 2024

Hepatol Int

View full text Add to dashboard Cite

Background and aims Performing a Transjugular intrahepatic portal system shunt (TIPS) in patients with portal vein cavernous transformation (CTPV) poses significant challenges. As an alternative, transjugular extrahepatic portal vein shunt (TEPS) may offer a potential solution for these patients. Nonetheless, the effectiveness and safety of TEPS remain uncertain. This case series study aimed to evaluate the efficacy and safety of TEPS in treating patients with CTPV portal hypertension complications. Methods The study encompassed a cohort of 22 patients diagnosed with CTPV who underwent TEPS procedures. Of these, 13 patients manifested recurrent hemorrhagic episodes subsequent to conventional therapies, 8 patients grappled with recurrent or refractory ascites, and 1 patient experienced acute bleeding but refused endoscopic treatment. Comprehensive postoperative monitoring was conducted for all patients to rigorously evaluate both the technical and clinical efficacy of the intervention, as well as long-term outcomes. Results The overall procedural success rate among the 22 patients was 95.5% (21/22).During the TEPS procedure, nine patients were guided by percutaneous splenic access, three patients were guided by percutaneous hepatic access, five patients were guided by transmesenteric vein access from the abdomen, and two patients were guided by catheter marking from the hepatic artery. Additionally, guidance for three patients was facilitated by pre-existing TIPS stents. The postoperative portal pressure gradient following TEPS demonstrated a statistically significant decrease compared to preoperative values (24.95 ± 3.19 mmHg vs. 11.48 ± 1.74 mmHg, p < 0.01).Although three patients encountered perioperative complications, their conditions ameliorated following symptomatic treatment, and no procedure-related fatalities occurred. During a median follow-up period of 14 months, spanning a range of 5 to 39 months, we observed four fatalities. Specifically, one death was attributed to hepatocellular carcinoma, while the remaining three were ascribed to chronic liver failure. During the follow-up period, no instances of shunt dysfunction were observed. Conclusions Precision-guided TEPS appears to be a safe and efficacious intervention for the management of CTPV.

show abstract

Transjugular extrahepatic portosystemic shunt (TEPS) creation in patients with complete occlusion of portal vein: Primary experience in a single medical center

Cited by 2 publications

References 5 publications

Efficacy and Safety of Precision-Guided Transjugular Extrahepatic Portosystemic Shunt (TEPS) in the Management of Cavernous Transformation of the Portal Vein with Portal Hypertension: A Case Series

Efficacy and Safety of Precision-Guided Transjugular Extrahepatic Portosystemic Shunt (TEPS) in the Management of Cavernous Transformation of the Portal Vein with Portal Hypertension: A Case Series

Efficacy and safety of precision-guided transjugular extrahepatic portosystemic shunt (TEPS) in the management of cavernous transformation of the portal vein with portal hypertension: a case series

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