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Fifteen years’ experience with transjugular intrahepatic portosystemic shunt (TIPS) using bare stents: retrospective review of clinical and technical aspects

Esperienza di quindici anni di shunt intraepatico porto-sistemico (TIPS) mediante utilizzo di stent non ricoperti: analisi retrospettiva degli aspetti clinici e tecnici

  • Vascular and Interventional Radiology Radiologia Vascolare ed Interventistica
  • Published:
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Abstract

Purpose

The authors present a retrospective analysis of a large series of patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement.

Materials and methods

Between March 1992 and December 2006, 658 patients were referred to our centre for TIPS placement. Indications for the procedure were digestive tract bleeding (52.8%), refractory ascites (35.3%), preservation of portal vein patency prior to liver transplantation (3.0%) and thrombosis of the suprahepatic veins (2.3%). Other indications (6.6%) included pleural ascites, portal thrombosis and hepatorenal and hepatopulmonary syndromes. All patients were evaluated with colour Doppler ultrasonography and in a few cases with computed tomography. The portal system was punctured under sonographic guidance. Wallstent, Palmaz and Nitinol thermosensitive stents were used. Embolisation of persistent varices was performed in 6.8% of cases.

Results

Technical success was 98.9%. During a 1,500-day follow-up, the cumulative incidence of stent revision was 25.7% (Nitinol), 32.9% (Wallstent) and 1.8% (Palmaz). Mortality rates were 31.1%, 38.5% and 56.4%, respectively. The technical complications included six cases of heart failure, six of haematobilia, three of stent migration, two of intrahepatic haematoma and one of haemoperitoneum. Eight patients with severe portosystemic encephalopathy (PSE) were treated with a reduction stent.

Conclusions

TIPS placement is safe and effective and may act as a bridge to liver transplantation. Ultrasonography plays a fundamental role in the preliminary assessment, in portal vein puncture and during the follow-up. Stent patency is satisfactory.

Riassunto

Obiettivo

Gli autori presentano un’analisi retrospettiva di un’ampia casistica di pazienti sottoposti a TIPS.

Materiali e metodi

Sono giunti al nostro centro per la TIPS 658 pazienti tra il marzo 1992 e il dicembre 2006. Le indicazioni alla procedura erano: sanguinamento digestivo (52,8%), ascite refrattaria (35,3%), “tutela” della pervietà portale pre-trapianto epatico (3,0%), trombosi delle vene sovraepatiche (2,3%). Altre indicazioni (6,6%) erano ascite pleurica, trombosi portale, sindrome epato-renale ed epato-polmonare. I pazienti sono stati studiati con ecocolor doppler, raramente con tomografia computerizzata; la puntura portale è stata ecoguidata. Sono stati impiegati stent Palmaz, Wallstent e termoespandibili. Nel 6,8% dei casi sono state embolizzate varici persistenti.

Risultati

Il successo tecnico è stato del 98,9%. Durante un follow-up di 1500 giorni, l’incidenza cumulativa di reintervento sugli stent è stata del 25,7% (Nitinol), 32,9% (Wallstent) e 1,8% (Palmaz); la mortalità è stata rispettivamente 31,1%, 38,5% e 56,4%. Le complicanze tecniche sono state: 6 insufficienze cardiache, 6 emobilie, 3 migrazioni di stent, 2 ematomi intraepatici ed 1 emoperitoneo. Otto pazienti con encefalopatia portosistemica (PSE) grave sono stati trattati con stent riduttore.

Conclusioni

La TIPS è sicura ed efficace, può rappresentare un ponte all’OLT. L’ecografia ha un ruolo fondamentale nello studio preliminare, durante la puntura portale e nel follow-up. La pervietà degli stent è soddisfacente.

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References/Bibliografia

  1. Saravanan R, Nayar M, Gilmore IT et al (2005) Transjugular intrahepatic portosystemic stent shunt: 11 years’ experience at a regional referral centre. Eur J Gastroenterol Hepatol 17:1165–1171

    Article  PubMed  Google Scholar 

  2. Wright AS, Rikkers LF (2005) Current management of portal hypertension. J Gastrointest Surg 9:992–1005

    Article  PubMed  Google Scholar 

  3. Boyer TD, Haskal ZJ (2005) American Association for the Study of Liver Diseases Practice Guidelines: the role of transjugular intrahepatic portosystemic shunt creation in the management of portal hypertension. J Vasc Int Radiol 16:615–629

    Google Scholar 

  4. Chalasani N, Kahi C, Francois F et al (2003) Improved patient survival after acute variceal bleeding: a multicenter, cohort study. Am J Gastroenterol 98:653–659

    Article  PubMed  Google Scholar 

  5. Russo MW, Sood A, Jacobson IM et al (2003) Transjugular intrahepatic portosystemic shunt for refractory ascites: an analysis of the literature on efficacy, morbidity and mortality. Am J Gastroenterol 98:2521–2527

    Article  PubMed  Google Scholar 

  6. Sanyal AJ, Gennig C, Reddy KR et al (2003) The North American Study for the Treatment of Refractory Ascites. Gastroenterology 124:634–641

    Article  PubMed  Google Scholar 

  7. de Vries GJ, Ryan BM, de Bievre M et al (2005) Cirrhosis related chylous ascites successfully treated with TIPS. Eur J Gastroenterol Hepatol 17:463–466

    Article  PubMed  Google Scholar 

  8. Therapondos G, Wong F (2006) Miscellaneous indications for transjugular intrahepatic portosystemic stent-shunt. Eur J Gastroenterol Hepatol 18:1161–1166

    Article  PubMed  Google Scholar 

  9. Gur C, Ilan Y, Shibolet O (2004) Hepatic hydrothorax - patophysiology, diagnosis and treatment - review of the literature. Liver Int 24:281–284

    Article  PubMed  Google Scholar 

  10. Spencer EB, Cohen DT, Darcy MD (2002) Safety and efficacy of transjugular intrahepatic portosystemic shunt creation for treatment of hepatic hydrothorax. J Vasc Int Radiol 13:385–390

    Article  Google Scholar 

  11. Chevallier P, Novelli L, Motamedi JP et al (2004) Hepatopulmonary syndrome successfully treated with transjugular intrahepatic portosystemic shunt: a three years follow-up. J Vasc Int Radiol 15:647–648

    Google Scholar 

  12. Ginès P, Guevara M, Arroyo V et al (2003) Hepatorenal syndrome. Lancet 362:1819–1827

    Article  PubMed  CAS  Google Scholar 

  13. Cardenas A, Uriz J, Ginès P et al (2000) Hepatorenal syndrome. Liver Transpl 6[suppl 1]:S63–S71

    PubMed  CAS  Google Scholar 

  14. Salerno F, Gerbes A, Ginès P et al (2007) Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. A consensus workshop of the international ascites club. GUT 56:1310–1318

    PubMed  CAS  Google Scholar 

  15. Arroyo V (2004) Review article: hepatorenal syndrome-how to assess response to treatment and nonpharmacological therapy. Aliment Pharmacol Ther 20[suppl 3]:49–54

    Article  PubMed  Google Scholar 

  16. Guevara M, Ginès P, Bandi JC et al (1998) Transjugular intrahepatic portosystemic shunt in hepatorenal syndrome: effects on renal function and vasoactive systems. Hepatology 28:416–422

    Article  PubMed  CAS  Google Scholar 

  17. Bressinger KA, Textor J, Perz P et al (2000) Long term outcome after transjugular intrahepatic stentshunt in non-transplant cirrhotics with hepatorenal syndrome: a phase II study. GUT 47:288–295

    Article  Google Scholar 

  18. Azoulay D, Buabse F, Damiano I et al (2001) Neoadiuvant transjugular intrahepatic portosystemic shunt: a solution for extrahepatic abdominal operation in cirrhotic patients with severe portal hypertension. J Am Coll Surg 193:46–51

    Article  PubMed  CAS  Google Scholar 

  19. Guglielmini A, Girlanda R, Lombardo F et al (1999) TIPS allowing for an endoscopic mucosal resection of early gastric cancer in a cirrhotic patient with severe hypertensive gastropathy: report of a case. Surg Today 29:902–905

    Article  Google Scholar 

  20. Grosso M, Nöldge G, Fava C et al (1998) Transjugular intrahepatic portosystemic shunt (TIPS). Indications, technique and results. Gnocchi Ed, Napoli

  21. Saad WEA, Saad NEA, Davies MG et al (2006) Elective transjugular intrahepatic portosystemic shunt creation for portal decompression in the immediate pretransplantation period in adult living related liver transplant recipient candidates: preliminary results. J Vasc Int Radiol 17:996–1002

    Google Scholar 

  22. Gooley TA, Leisenring W, Crowley J, Storer BE (1999) Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. Stat Med 18:695–706

    Article  PubMed  CAS  Google Scholar 

  23. Gray RJ (1988). A class of K-sample tests for comparing the cumulative incidence of a competing risk. Annals of Statistics 16:1141–1154

    Article  Google Scholar 

  24. Sahagun G, Benner KG, Saxon R et al (1997) Outcome of 100 patients after transgiugular intrahepatic portosystemic shunt for variceal hemmorhrage. Am J Gastroenterol 92:1444–1452

    PubMed  CAS  Google Scholar 

  25. Sanyal AJ, Freedman AM, Luketic VA et al (1997) The natural history of portal hypertension after transgiugular intrahepatic portosystemic shunts. Gastroenterology 112:889–898

    Article  PubMed  CAS  Google Scholar 

  26. Kessler J, Trerotola S (2006) Use of the Amplatzer Vascular Plug for emgolization of a large retroperitoneal shunt during transgiugular intrahepatic portosystemic shunt creation for gastric variceal bleeding. J Vasc Interv Radiol 17:135–140

    Article  PubMed  Google Scholar 

  27. Tesdal IK, Filser T, Weiss C et al (2005) Transgiugular intrahepatic portosystemic shunts: adjunctive embolotherapy of gastroesophageal collateral vessels in the prevention of variceal rebleeding. Radiology 236:360–367

    Article  PubMed  Google Scholar 

  28. McKusick MA (1999) Interventional radiology for the control and prevention bleeding. Gastrointest Endosc Clin Noth Am 9:311–329

    CAS  Google Scholar 

  29. Rössle M, Grandt D (2004) TIPS: an update. Best Pract Res Clin Gastroenterol 18:99–123

    Article  PubMed  Google Scholar 

  30. Senzolo M, Cholongitas E, Tibballs J et al (2006) Transgiugular intrahepatic portosystemic shunt in the management of ascites and hepatorenal syndrome. Eur J Gastroenterol Hepatol 18:1143–1150

    Article  PubMed  Google Scholar 

  31. Thuluvath PJ, Bal JS, Mitchell S et al (2003) TIPS management of refractory ascites: response and survival are both unpredictable. Dig Dis Sci 48:542–550

    Article  PubMed  Google Scholar 

  32. Ferrante D, Arguendas MR, Cerfolio RJ et al (2002) Videoassisted thoracoscopic surgery with talc pleurodesis in the management of symptomatic hepatic hydrothorax. Am J Gastroenterol 97:3172–3175

    Article  PubMed  Google Scholar 

  33. Gordon FD, Anastopoulos HT, Crenshaw W et al (1997) The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt. Hepatology 25:1366–1369

    Article  PubMed  CAS  Google Scholar 

  34. Rossle M, Haag K, Ochs A et al (1994) The transgiugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding. N Engl J Med 330:165–171

    Article  PubMed  CAS  Google Scholar 

  35. Strauss RM, Boyer TD (1997) Hepatic hydrothorax. Semin Liver Dis; 17:227–232

    Article  PubMed  CAS  Google Scholar 

  36. Freedman AM, Sanyal AJ, Tisnado J et al (1993) Complications of transgiugular intrahepatic portosystemic shunt: a comprehensive review. RadioGraphics 13:1185–1210

    PubMed  CAS  Google Scholar 

  37. Murad SD, Luong TK, Pattynama PM et al (2008) Long-term outcome of a covered vs. uncovered transgiugular intrahepatic portosystemic shunt in Budd-Chiari syndrome. Liv Int 249–256

  38. Vignali C, Bargellini I, Grosso M et al (2005) TIPS with expanded polytetrafluoroethylene-covered stent: results of an italian multicenter study. AJR Am J Roentgenol 185:472–480

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Diagnostic and Interventional Radiology Institute, A.S.O. San Giovanni Battista, Via Genova 3, 10126, Turin, Italy

    C. Gazzera, D. Righi, F. Valle & G. Gandini

  2. Gastroenterology and Hepatology Division, A.S.O. San Giovanni Battista, C.so Bramante 88, 10126, Turin, Italy

    A. Ottobrelli

  3. Radiology Service, Ospedale Santa Croce e Carle, Via Coppino 26, 12100, Cuneo, Italy

    M. Grosso

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  1. C. Gazzera
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  2. D. Righi
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  5. M. Grosso
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  6. G. Gandini
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Correspondence to C. Gazzera.

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Gazzera, C., Righi, D., Valle, F. et al. Fifteen years’ experience with transjugular intrahepatic portosystemic shunt (TIPS) using bare stents: retrospective review of clinical and technical aspects. Radiol med 114, 83–94 (2009). https://doi.org/10.1007/s11547-008-0349-3

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