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6-mm shunt transjugular intrahepatic portosystemic shunt in patients with severe liver atrophy and variceal bleeding

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Abstract

Objectives

We proposed a strategy for the creation of a 6-mm transjugular intrahepatic portosystemic shunt (TIPS) and to assess its effectiveness compared to a conventional 8-mm shunt for TIPS-induced hepatic encephalopathy (HE).

Methods

Patients were reviewed retrospectively using propensity score matching (1:1) and divided into 6-mm and 8-mm shunt groups based on shunt diameter. The stent patency, HE incidence, and rebleeding rate between the two groups were then compared.

Results

From January 2018 to June 2021, both 6-mm shunt group and 8-mm shunt group included 58 patients. The 6-mm shunt group had significantly smaller liver volumes (879.3 ± 237.1 vs. 1008.8 ± 293.0; p = 0.010), and the median stent patency times were 30.7 and 33.8 months in the 6-mm and 8-mm groups, respectively (p = 0.124). No statistically significant difference was found between the two groups in the 1-year (8.6% vs. 3.4%; p = 0.242) and 2-year (17.2% vs. 12.1%; p = 0.242) rebleeding rates. The 1-year cumulative incidences of overt HE were 12.1% and 27.6% in the 6-mm and 8-mm groups, respectively (p = 0.040), and the 2-year cumulative overt HE incidences in these groups were 19.0% and 36.2%, respectively (p = 0.038). Notably, patients with a 6-mm shunt also experienced less hepatic impairment.

Conclusions

For patients with variceal bleeding and a small liver volume, the 6-mm shunt significantly reduced the incidence of overt HE, protected perioperative liver function, and did not affect stent patency or rebleeding rate.

Clinical relevance statement

For patients with variceal bleeding with small liver volume, the 6-mm transjugular intrahepatic portosystemic shunt (TIPS) significantly reduced the incidence of overt hepatic encephalopathy after TIPS, protected perioperative liver function, and did not affect stent patency and rebleeding rate.

Key Points.

• A strategy for the creation of a 6-mm transjugular intrahepatic portosystemic shunt for patients with variceal bleeding and a small liver volume was proposed.

• The 6-mm transjugular intrahepatic portosystemic shunt significantly reduced the incidence of overt hepatic encephalopathy.

• The 6-mm transjugular intrahepatic portosystemic shunt did not affect stent patency or rebleeding rate.

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Abbreviations

ALB:

Albumin

CDUS:

Color Doppler ultrasound

CI:

Confidence interval

C-P:

Child-Pugh

HE:

Hepatic encephalopathy

HR:

Hazard ratio

MELD:

Model for end-stage liver disease

OS:

Overall survival

PPG:

Portal pressure gradient

PT:

Prothrombin time

TIPS :

Transjugular intrahepatic portosystemic shunt

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Acknowledgements

We thank the patients enrolled in this study.

Funding

This work was supported by National Natural Science Foundation (fund No: 82072035).

Role of the Funder: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Author notes

  1. Huzheng Yan, Zhanwang Xiang, Mingan Li and Mingsheng Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

    Huzheng Yan, Zhanwang Xiang, Chenghao Zhao, Shuyang Luo, Huan Liu, Mingan Li & Mingsheng Huang

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  1. Huzheng Yan
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  2. Zhanwang Xiang
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  3. Chenghao Zhao
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  4. Shuyang Luo
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  5. Huan Liu
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  6. Mingan Li
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  7. Mingsheng Huang
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Corresponding authors

Correspondence to Mingan Li or Mingsheng Huang.

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Guarantor

The scientific guarantor of this publication is Mingsheng Huang.

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

The Third Affiliated Hospital of Sun Yat-sen University approved the study and waived the requirement of informed consent because of its low risk.

Ethical approval

The Third Affiliated Hospital of Sun Yat-sen University approved the study and waived the requirement of informed consent because of its low risk.

Study subjects or cohorts overlap

No study subjects or cohorts have been previously reported in any elsewhere.

Methodology

• Retrospective

• case–control study

• performed at one institution

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Yan, H., Xiang, Z., Zhao, C. et al. 6-mm shunt transjugular intrahepatic portosystemic shunt in patients with severe liver atrophy and variceal bleeding. Eur Radiol (2023). https://doi.org/10.1007/s00330-023-10346-3

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  • DOI: https://doi.org/10.1007/s00330-023-10346-3

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