Transjugular intrahepatic porto-systemic shunt in the elderly: Palliation for complications of portal hypertension

Abstract

AIM: To present a dedicated series of transjugular intrahepatic porto-systemic shunts (TIPS) in the elderly since data is sparse on this population group. METHODS: A retrospective review was performed of patients at least 65 years of age who underwent TIPS at our institutions between 1997 and 2010. Twenty-five patients were referred for TIPS. We deemed that 2 patients were not considered appropriate candidates due to their markedly advanced liver disease. Of the 23 patients suitable for TIPS, the indications for TIPS placement was portal hypertension complicated by refractory ascites alone (n = 9), hepatic hydrothorax alone (n = 2), refractory ascites and hydrothorax (n = 1), gastrointestinal bleeding alone (n = 8), gastrointestinal bleeding and ascites (n = 3). RESULTS: Of these 23 attempted TIPS procedure patients, 21 patients had technically successful TIPS procedures. A total of 29 out of 32 TIPS procedures including revisions were successful in 21 patients with a mean age of 72.1 years (range 65-82 years). Three of the procedures were unsuccessful attempts at TIPS and 8 procedures were successful revisions of our existing TIPS. Sixteen of 21 patients who underwent successful TIPS (excluding 5 patients lost to follow-up) were followed for a mean of 14.7 mo. Ascites and/or hydrothorax was controlled following technically successful procedures in 12 of 13 patients. Bleeding was controlled following technically successful procedures in 10 out of 11 patients. CONCLUSION: We have demonstrated that TIPS is an effective procedure to control refractory complications of portal hypertension in elderly patients

Permanent indwelling peritoneal catheters for palliation of refractory ascites in end‐stage liver disease: A systematic review

“…Meta‐analyses comparing TIPS with LVP reported TIPS to be more effective in reducing ascites recurrence, however with a greater incidence of HE (prevalence 15%‐61%); with conflicting survival outcome data . In one small retrospective study (n = 10) of palliative TIPS for RA ± hepatic hydrothorax in ESLD, 50% developed HE with more than half subsequently dying within three months …”

“…4 In one small retrospective study (n = 10) of palliative TIPS for RA ± hepatic hydrothorax in ESLD, 50% developed HE with more than half subsequently dying within three months. 41 The ALFApump ® involves an implantable device pumping ascites from the peritoneal cavity into the bladder. 42 Consistent with the initial European multicentre safety and efficacy study and the multicentre RCT, 43,44 recent studies have corroborated complication rates of infections (11%-56%), 45,46 renal dysfunction (21%-67%), [45][46][47] device deficiency including catheter occlusion (9%-33%) 45,46 and explantation rates of up to 30%.…”

Outcomes After Transjugular Intrahepatic Portosystemic Shunt in Cirrhotic Patients 70 Years and Older

“…TIPS results in lower re-bleeding rates and improved survival in patients who undergo TIPS for recurrent esophageal variceal bleeding or within 72 h of esophageal variceal bleeding [7,10,11]. The benefit for TIPS and refractory ascites is improvement in quality of life with decreased need for large volume paracentesis, while a survival benefit for this indication has not been consistently demonstrated [15,18,[22][23][24][25][26]. A well-recognized complication of TIPS is HE, which can be disabling and more disabling than the indication for TIPS, such as ascites.…”

“…Prior retrospective studies have evaluated TIPS outcomes in patients 60 years and older [14][15][16] reporting increased rates of encephalopathy or short-term mortality in this older age group [12,14,[17][18][19][20][21]. The purpose of our study was to report outcomes after TIPS in patients 70 years of age and older including rates of HE and 30 d readmissions after TIPS.…”

Transjugular intrahepatic portosystemic shunt using the FLUENCY expanded polytetrafluoroethylene-covered stent

“…Transjugular intrahepatic portosystemic stent shunt (TIPS) is an effective treatment for esophageal variceal hemorrhage caused by portal hypertension (1,2). It has been demonstrated that compared with medical treatment and endoscopic treatment, the early use of a TIPS in patients with hemorrhages improves the survival rate significantly.…”