Transjugular Portosystemic Shunt Reductions: A Retrospective Single-Center Experience

Arthur S. Joseph, Barjinder Sandhu, Adam Khalil, Jorge E Lopera

Research output: Contribution to journalArticle

Abstract

Purpose: To report the results of transjugular intrahepatic portosystemic shunt (TIPS)reductions for hepatic encephalopathy (HE), acute liver failure (ALF), and pulmonary hypertension (PH). Materials and Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)876-884
Number of pages9
JournalJournal of Vascular and Interventional Radiology
Volume30
Issue number6
DOIs
StatePublished - Jun 1 2019

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Transjugular Portosystemic Shunt Reductions: A Retrospective Single-Center Experience'. Together they form a unique fingerprint.

  • Cite this