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Adjuvant Transjugular Variceal Occlusion at Creation of a Transjugular Intrahepatic Portosystemic Shunt (TIPS): Efficacy and Risks of Bucrylate Embolization

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Abstract

Adjuvant embolization of varices may reduce rebleeding in patients with a transjugular intrahepatic portosystemic shunt (TIPS). The aim of this study was to investigate the efficacy and the risks of adjuvant variceal embolization at TIPS implantation using bucrylate.

Patients and Methods

The retrospective study evaluated 104 of 237 cirrhotic patients with TIPS for variceal bleeding who received adjuvant bucrylate embolization. For TIPS creation, bare stents were used in 35 patients (33.7%) and covered stents in 69 patients (66.3%) patients. Isolated gastric varices were seen in 10 patients (9.6%).

Results

Six patients (5.8%) rebled during a median follow-up time of 26 months (1–57 months). Rebleeding occurred in 14% (5/35) of patients with a bare stent but only in 1.4% (1/69) of patients with a covered stent. The 1- and 2-year rebleeding rates of all patients were 0.9 and 2.9% and of patients receiving a bare stent were 2.9 and 8.6%, respectively. Bucrylate migration was seen in 13 patients (12.5%). In 9 of these patients (8.7%), asymptomatic lung embolization occurred. This was rare in patients with esophageal varices (3.1%) but frequent (60%) in patients with isolated gastric varices and a spontaneous splenorenal shunt.

Conclusions

Our results suggest that adjuvant embolization using bucrylate is effective and delays variceal rebleeding. The general use of covered stents, however, alleviates the utility of adjuvant bucrylate embolization which may be restricted to patients with a high risk of rebleeding indicated by large varices, active, acute or recent variceal bleeding and advanced cirrhosis. Bucrylate should not be used in isolated gastric varices because it bears a high risk of migration into the lungs.

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Authors and Affiliations

  1. Department of Gastroenterology, University Hospital of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany

    Michael Schultheiß, Max Giesler, Arthur Schmidt, Lukas Sturm, Robert Thimme, Martin Rössle & Dominik Bettinger

  2. Department of Radiology, University Hospital of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany

    Lars Maruschke

Authors
  1. Michael Schultheiß
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  2. Max Giesler
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  3. Lars Maruschke
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  4. Arthur Schmidt
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  5. Lukas Sturm
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  6. Robert Thimme
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  7. Martin Rössle
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  8. Dominik Bettinger
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Contributions

MS performed interventions, designed and conducted the study and wrote the manuscript. MG, AS and LS collected the data and wrote the manuscript. LM performed interventions and was involved in documentation of data. RT designed the study and reviewed the manuscript. MR performed the interventions, designed the study, evaluated the data and wrote the manuscript. DB wrote the manuscript and collected statistics.

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Correspondence to Martin Rössle.

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Schultheiß, M., Giesler, M., Maruschke, L. et al. Adjuvant Transjugular Variceal Occlusion at Creation of a Transjugular Intrahepatic Portosystemic Shunt (TIPS): Efficacy and Risks of Bucrylate Embolization. Cardiovasc Intervent Radiol 42, 729–736 (2019). https://doi.org/10.1007/s00270-019-02176-y

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  • DOI: https://doi.org/10.1007/s00270-019-02176-y

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