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Right vs left portal branch puncture in TIPS creation with controlled expansion covered stent: comparison of hemodynamic and clinical outcomes

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Abstract

Purpose

To retrospectively compare outcomes of TIPS performed by puncturing left portal vein (LPV) vs right portal vein (RPV) to access the portal system.

Materials and methods

One hundred ninety-three consecutive patients underwent TIPS with controlled expansion covered stent by using the LPV (37 patients) or the RPV (156 patients). Patients were followed until the last clinical evaluation, liver transplantation, or death.

Results

Demographics and clinical characteristics of the two groups were comparable. The median follow-up was 9.6 months (range 0.1–50.6). Portosystemic pressure gradient (PSG) before TIPS 15.7 mmHg ± 4.7 in RPV group (RPVG) vs 15.4 mmHg ± 4.5 in LPV group (LPVG) (p = 0.725). After TIPS, PSG 6.3 mmHg ± 2.8 in RPVG vs 6.2 mmHg ± 2.2 (p = 0.839). In LPVG, the stent was dilated to 8-mm in 95% of patients vs 77% of RPVG (p = 0.015). Two (5.4%) and 22 (14%) patients underwent TIPS revision in LPVG and RPVG (p = 0.15). The incidence of overt HE was 13% in LPVG and 24% in RPVG (p = 0.177). Rebleeding occurred in 3 of 49 patients (6%) with variceal bleeding as an indication: 2/41 patients (4.9%) in RPVG vs 1/8 patients (12.5%) in LPVG (p = 0.417). Among 126 patients with refractory ascites 20 patients (15.9%) needed paracentesis 3 months after the procedure: 18/101 patients (17.8%) in RPVG vs 2/25 patients (8%) in LPVG (p = 0.231). Thirty-seven patients (19%) died: 32 (21%) in RPVG and 5 (14%) in LPVG (p = 0.337).

Conclusion

Compared with RPV puncture, in TIPS created through the LPV, the targeted PSG was reached with a smaller stent diameter. However, no significant difference in clinical outcomes was observed.

Key Points

• A LPV approach for TIPS creation does not lead to better control of complications of portal hypertension as compared to a RPV approach.

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Abbreviations

HE:

Hepatic encephalopathy

LPV:

Left portal vein

LPVG:

Left portal vein group

PSG:

Portosystemic pressure gradient

RA:

Refractory ascites

RPV:

Right portal vein

RPVG:

Right portal vein group

TIPS:

Transjugular intrahepatic portosystemic shunt

VB:

Variceal bleeding

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Roberto Miraglia and Luigi Maruzzelli have contributed equally to this study and share the first authorship.

Authors and Affiliations

  1. Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy

    Roberto Miraglia, Luigi Maruzzelli, Giuseppe Mamone & Angelo Luca

  2. Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy

    Ioannis Petridis

  3. Statistics and Data Management Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy

    Fabio Tuzzolino

Authors
  1. Roberto Miraglia
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  2. Luigi Maruzzelli
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  3. Giuseppe Mamone
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  4. Ioannis Petridis
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  5. Fabio Tuzzolino
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  6. Angelo Luca
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Corresponding author

Correspondence to Giuseppe Mamone.

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Guarantor

The scientific guarantor of this publication is Roberto Miraglia.

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

Fabio Tuzzolino kindly provided statistical advice for this manuscript.

Informed consent

Our retrospective cohort study was reviewed and approved by the institutional research review board, and informed consent form was waived. Informed written consent to the TIPS procedure was obtained in all patients.

Ethical approval

Our retrospective cohort study was reviewed and approved by the institutional research review board, and informed consent form was waived. Informed written consent to the TIPS procedure was obtained in all patients.

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• retrospective

• observational

• performed at one institution

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Miraglia, R., Maruzzelli, L., Mamone, G. et al. Right vs left portal branch puncture in TIPS creation with controlled expansion covered stent: comparison of hemodynamic and clinical outcomes. Eur Radiol 33, 2647–2654 (2023). https://doi.org/10.1007/s00330-022-09280-7

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  • DOI: https://doi.org/10.1007/s00330-022-09280-7

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