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Transjugular Intrahepatic Portosystemic Shunt Placement During Pregnancy: A Case Series of Five Patients

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Abstract

Background and Aims

Complications of portal hypertension, such as variceal hemorrhage and ascites, are associated with significant increases in both mortality and complications during pregnancy. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure for treating portal hypertension, but the safety of TIPS during pregnancy is largely unknown. In this series, we review five patients who underwent TIPS placement while pregnant and describe their clinical outcomes.

Methods

Five pregnant patients with cirrhosis and portal hypertension underwent elective TIPS for complications of portal hypertension (four for secondary prevention of variceal bleeding and one for refractory ascites). Outcomes measured were recurrent bleeding episodes or need for further paracenteses during pregnancy, estimated radiation dose to the fetus and gestational age at delivery. All patients were followed after delivery to evaluate technical and clinical success of the procedure.

Results

All five patients survived pregnancy and went on to deliver successfully. When TIPS was performed for secondary prevention of variceal bleeding (n = 4), no patients demonstrated variceal bleeding after TIPS placement. When TIPS was performed for refractory ascites (n = 1), no further paracenteses were required. All patients delivered successfully, albeit prematurely. Average radiation dose estimated to the fetus was 16.3 mGy.

Conclusions

This series suggests that TIPS can be performed in selective pregnant patients with portal hypertension, with little added risk to the mother or fetus.

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Conflict of interest

All authors declare that they have no financial conflicts of interest with this manuscript or its content. This study was not supported by grant funding.

Statement of Informed Consent

This study was approved by the hospital’s institutional review board (IRB). For this type of study, formal consent is not required.

Statement of Human and Animal Rights

All procedures performed in this study which involved human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Department of Interventional Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195-7115, USA

    Christopher R. Ingraham, Siddharth A. Padia, Guy E. Johnson & Karim Valji

  2. Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA

    Thomas R. Easterling

  3. Department of Medicine, University of Washington, Seattle, WA, USA

    Iris W. Liou

  4. Physics Section, Department of Radiology, University of Washington, Seattle, WA, USA

    Kalpana M. Kanal

Authors
  1. Christopher R. Ingraham
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  2. Siddharth A. Padia
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  3. Guy E. Johnson
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  4. Thomas R. Easterling
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  5. Iris W. Liou
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  6. Kalpana M. Kanal
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  7. Karim Valji
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Corresponding author

Correspondence to Christopher R. Ingraham.

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Ingraham, C.R., Padia, S.A., Johnson, G.E. et al. Transjugular Intrahepatic Portosystemic Shunt Placement During Pregnancy: A Case Series of Five Patients. Cardiovasc Intervent Radiol 38, 1205–1210 (2015). https://doi.org/10.1007/s00270-015-1053-z

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  • DOI: https://doi.org/10.1007/s00270-015-1053-z

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