Transjugular Portosystemic Shunt Reductions: A Retrospective Single-Center Experience

• Published in: Journal of vascular and interventional radiology Vol. 30; no. 6; pp. 876 - 884
• Main Authors: Joseph, Arthur S., Sandhu, Barjinder, Khalil, Adam, Lopera, Jorge
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2019
• Subjects: Adult; Aged; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - instrumentation; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Databases, Factual; Female; Hepatic Encephalopathy - etiology; Hepatic Encephalopathy - physiopathology; Hepatic Encephalopathy - surgery; Humans; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Hypertension, Pulmonary - surgery; Liver Failure, Acute - etiology; Liver Failure, Acute - physiopathology; Liver Failure, Acute - surgery; Male; Middle Aged; Portasystemic Shunt, Transjugular Intrahepatic - adverse effects; Reoperation; Retrospective Studies; Risk Factors; Stents; Texas; Time Factors; Treatment Outcome; Young Adult; Texas; PH; ALF; MELD-Na; PSG; HE; TIPS
• ISSN: 1051-0443; 1535-7732; 1535-7732
• DOI: 10.1016/j.jvir.2019.01.031

To report the results of transjugular intrahepatic portosystemic shunt (TIPS) reductions for hepatic encephalopathy (HE), acute liver failure (ALF), and pulmonary hypertension (PH). A single-institution retrospective review analysis was performed between 2007 and 2017 on patients undergoing TIPS reduction at single tertiary liver transplant center. A total of 27 patients (14 males and 13 females) underwent TIPS reduction for refractory HE (n = 18), ALF (n = 7), and PH (n = 2). The average age at time of reduction was 59 years (range, 23–73; standard deviation [SD], 8). Mean prereduction Model of End-State Liver Disease-Na and portosystemic pressure gradient were 19 (range, 11–29; SD, 6) and 9.4 mm Hg (range, –2 to 19; SD, 4.8), respectively. Comparison between responders and nonresponders was performed for multiple variables using a 2-tailed t test. Methods of reduction were compared in cases of HE. Technical success, defined as a decrease of at least 50% of the caliber of the shunt, was 100%. Clinical success rates in improving HE, ALF, and PH were calculated at 89%, 71%, and 100%, respectively. Eight patients had major and 10 had minor complications after the reductions. There were 3 shunt thrombosis. Pre- and postreduction Model of End-State Liver Disease-Na, portosystemic pressure gradient change, duration of indwelling TIPS, and reduction method were not significantly different between responders and nonresponders. Six-month survival rates were 80%, 20%, and 100% for HE, ALF, and PH, respectively. TIPS reduction is effective in reversing refractory HE, ALF, and PH after TIPS creation. TIPS reduction is associated with a high rate of complications and should be reserved for severe refractory overshunting complications.