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Comparison of transjugular intrahepatic portosystemic shunt (TIPS) alone and combined with embolisation for the management of cardiofundal varices: a retrospective study

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To assess the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with and without adjunctive embolisation in managing cardiofundal varices bleeding.

Methods

The retrospective study comprised 82 patients (54 men; mean age 53.9 years; mean Model of End-stage Liver Disease score 9.3) with cardiofundal varices bleeding who underwent TIPS creation from 2011 to 2015. Variceal rebleeding, the outflow tracts of varices, overt hepatic encephalopathy (HE) and post-procedure varices patency were assessed.

Results

Gastrorenal shunt was present in 92.7% of patients (n = 76). Embolisation was performed in 67.1% of patients (n = 55). The 1- and 2-year variceal rebleeding rates in the TIPS combined with embolisation group were significantly lower than those in the TIPS alone group (3.8% and 13.4% vs 13.0% and 28.0%, respectively; p = 0.041). No significant differences between the two groups were found in the cardiofundal varices patency, overt HE or survival (p > 0.05).

Conclusions

The results suggest that TIPS combined with embolisation can reduce the risk of variceal rebleeding for patients with cardiofundal varices.

Key Points

• TIPS combined with embolisation reduces the risk of rebleeding in treating cardiofundal varices.

• TIPS combined with embolisation could not completely occlude cardiofundal varices.

• TIPS combined with embolisation could not prevent the development of hepatic encephalopathy.

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Abbreviations

BRTO:

Balloon-occluded retrograde transvenous obliteration

CECT:

Contrast-enhanced computed tomography

GOV:

Gastro-oesophageal varices

GVs:

Gastric varices

HE:

Hepatic encephalopathy

IGV:

Isolated gastric varices

LGV:

Left gastric vein

PGV:

Posterior gastric vein

PSG:

Portosystemic pressure gradient

SGV:

Short gastric vein

TIPS:

Transjugular intrahepatic portosystemic shunt

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Funding

This study has received funding by the Beijing Hope Run Special Fund of Cancer Foundation of China (Grant No. LC2015A01 to X.L.).

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Authors and Affiliations

  1. Institute of Interventional Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Jiaze Yu, Huaiyuan Ma & Xiao Li

  2. Medical Imaging Department, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, 650032, Yunnan, China

    Xiaoze Wang

  3. Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Mingshan Jiang & Li Yang

  4. Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Zilin Zhou

  5. Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China

    Xiao Li

Authors
  1. Jiaze Yu
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  2. Xiaoze Wang
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  4. Huaiyuan Ma
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  6. Li Yang
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  7. Xiao Li
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Corresponding author

Correspondence to Xiao Li.

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Guarantor

The scientific guarantor of this publication is Xiao Li.

Conflict of Interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and Biometry

No complex statistical methods were necessary for this paper.

Informed Consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical Approval

Institutional review board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Yu, J., Wang, X., Jiang, M. et al. Comparison of transjugular intrahepatic portosystemic shunt (TIPS) alone and combined with embolisation for the management of cardiofundal varices: a retrospective study. Eur Radiol 29, 699–706 (2019). https://doi.org/10.1007/s00330-018-5645-2

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  • DOI: https://doi.org/10.1007/s00330-018-5645-2

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