Comparison of transjugular intrahepatic portosystemic shunt (TIPS) alone and combined with embolisation for the management of cardiofundal varices: a retrospective study
- 183 Downloads
To assess the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with and without adjunctive embolisation in managing cardiofundal varices bleeding.
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.
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).
The results suggest that TIPS combined with embolisation can reduce the risk of variceal rebleeding for patients with cardiofundal varices.
• 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.
KeywordsTIPSS Gastric varix Embolotherapy Portal hypertension Bleeding
Abbreviations and acronyms
Balloon-occluded retrograde transvenous obliteration
Contrast-enhanced computed tomography
Isolated gastric varices
Left gastric vein
Posterior gastric vein
Portosystemic pressure gradient
Short gastric vein
Transjugular intrahepatic portosystemic shunt
This study has received funding by the Beijing Hope Run Special Fund of Cancer Foundation of China (Grant No. LC2015A01 to X.L.).
Compliance with Ethical Standards
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.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional review board approval was obtained.
• performed at one institution
- 12.Jalan R, Redhead DN, Forrest EH, Hayes PC (1995) Relationship between directly measured portal pressure gradient and variceal hemorrhage. Am J Gastroenterol 90:1994–1996Google Scholar
- 14.Lakhoo J, Bui JT, Lokken RP, Ray CE Jr, Gaba RC (2016) Transjugular intrahepatic portosystemic shunt creation and variceal coil or plug embolization ineffectively attain gastric variceal decompression or occlusion: results of a 26-patient retrospective study. J Vasc Interv Radiol 27:1001–1011CrossRefGoogle Scholar
- 24.Luo X, Ma H, Yu J, Zhao Y, Wang X, Yang L (2017) Efficacy and safety of balloon-occluded retrograde transvenous obliteration of gastric varices with lauromacrogol foam sclerotherapy: initial experience. Abdom Radiol. https://doi.org/10.1007/s00261-017-1346-6
- 28.Wang Q, Lv Y, Bai M et al (2017) Eight millimeter covered TIPS does not compromise shunt function but reduces hepatic encephalopathy in preventing variceal rebleeding. J Hepatol. https://doi.org/10.1016/j.jhep.2017.05.006
- 32.Lv Y, Qi X, He C et al (2017) Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial. Gut. https://doi.org/10.1136/gutjnl-2017-314634