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Efficacy, feasibility and safety of TIPS in the treatment of recurrent portal hypertension with variceal bleeding after open splenectomy and esophagogastric devascularization

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the efficacy, feasibility, and safety of transjugular intrahepatic portosystemic shunt (TIPS) as a treatment for patients with recurrent portal hypertension with variceal bleeding (RPHVB) who have previously undergone open splenectomy and esophagogastric devascularization (OSED).

Methods

The data were retrospectively retrieved from 39 cirrhotic RPHVB patients who had undergone OSED from August 2015 to December 2020. All patients were treated with TIPS using the Viabahn stent.

Results

Out of the 39 patients included in the study, TIPS was successfully performed in 38 patients with a success rate of 97.44%. One patient had a failed attempt due to cavernous transformation of the portal vein (CTPV). Among the 38 patients who underwent TIPS, 33 patients also underwent varicose vein embolization, while the remaining 5 patients only underwent TIPS procedure. A total of 39 Viabahn stents were implanted, with 5 patients receiving stents expanded to their nominal diameter of 8 mm and the remaining 33 patients having their shunt maintained at a diameter of 6 mm. The postoperative hemostasis rate was 97.37% (37/38). The portal vein pressure (PVP) and portal pressure gradient (PPG) decreased significantly from (31.28 ± 6.24) and (20.61 ± 5.14) mmHg to (19.58 ± 4.69) and (9.24 ± 3.07) mmHg, respectively (P < 0.001). During the follow-up period, the rebleeding rate was 6.09% (2/29), while the incidence of hepatic encephalopathy (HE) and shunt dysfunction was 13.79% (4/29) for each.

Conclusion

Transjugular intrahepatic portosystemic shunt is an effective, feasible and safe treatment for RPHVB patients who have previously undergone OSED. A satisfactory clinical outcome could be achieved with a 6 mm-diameter shunt in most patients.

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Data availability

All data and materials are available upon reasonable request to the corresponding author.

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Author notes

  1. Zhongkai Wang and Zhiyuan Zhang contributed equally to this study.

Authors and Affiliations

  1. Department of Interventional Radiology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Road, Xuzhou, 221006, Jiangsu, China

    Zhongkai Wang, Xiao Guo, Wei Xu, Ning Wei, Qingqiao Zhang, Maoheng Zu & Hao Xu

  2. Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210009, Jiangsu, China

    Zhongkai Wang

  3. Department of Interventional Oncology, The Second Affiliated Hospital of Xuzhou Medical University, 32 Meijian Road, Xuzhou, 221006, Jiangsu, China

    Zhiyuan Zhang

  4. Department of Intervention, The Huai’an Hospital, 19 Shan-Yang Road, Huai’an, 223200, Jiangsu, China

    Xiao Guo

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  1. Zhongkai Wang
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Contributions

ZW and ZZ contributed equally to this study. ZW and ZZ designed and wrote the manuscript. ZW, ZZ and XG collected and analyzed the data. WX, NW, QZ, MZ and HX critically revised the manuscript.

Corresponding author

Correspondence to Hao Xu.

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Competing interests

The authors of this work have nothing to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Our study was approved by the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University (Jiangsu, China; XYFY2015-JS020-01). All enrolled patients gave written informed consent. All methods were carried out in accordance with relevant guidelines and regulations.

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Wang, Z., Zhang, Z., Guo, X. et al. Efficacy, feasibility and safety of TIPS in the treatment of recurrent portal hypertension with variceal bleeding after open splenectomy and esophagogastric devascularization. Abdom Radiol (2023). https://doi.org/10.1007/s00261-023-03945-7

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