The presence of spontaneous portosystemic shunts increases the risk of complications after transjugular intrahepatic portosystemic shunt (TIPS) placement

• DOI: 10.1016/j.diii.2016.02.004
• Publication Date: 2016-03-02T21:29:36Z
• Authors: P. Borentain; J. Soussan; N. Resseguier; D. Botta-Fridlund; J.-C. Dufour; R. Gérolami; V. Vidal
• Keywords: Liver Cirrhosis; Male; 0301 basic medicine; [SDV.MHEP.PSM] Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health; [SHS.PSY]Humanities and Social Sciences/Psychology; Esophageal and Gastric Varices; Transjugular intrahepatic portosystemic shunt; [SHS.PSY] Humanities and Social Sciences/Psychology; 03 medical and health sciences; Postoperative Complications; Humans; Portal hypertension; [SHS.ECO] Humanities and Social Sciences/Economics and Finance; Hepatic encephalopathy; Portal Vein; Ascites; Middle Aged; [SHS.ECO]Humanities and Social Sciences/Economics and Finance; 3. Good health; [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie; [SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health; Hepatic Encephalopathy; [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie; Female; Spontaneous portosystemic shunt; Portasystemic Shunt, Transjugular Intrahepatic; Gastrointestinal Hemorrhage

The goal of this study was to identify clinical and imaging variables that are associated with an unfavorable outcome during the 30 days following transjugular intrahepatic portosystemic shunt (TIPS) placement.Fifty-four consecutive patients with liver cirrhosis (Child-Pugh 6-13, Model for End-stage Liver Disease 7-26) underwent TIPS placement for refractory ascites (n=25), recurrent or uncontrolled variceal bleeding (n=23) or both (n=6). Clinical, biological and imaging variables including type of stent (covered n=40; bare-stent n=14), presence of spontaneous portosystemic shunt (n=31), and variations in portosystemic pressure gradient were recorded. Early severe complication was defined as the occurrence of overt hepatic encephalopathy or death within the 30days following TIPS placement.Sixteen patients (30%) presented with early severe complication after TIPS placement. Child-Pugh score was independently associated with complication (HR=1.52, P<0.001). Among the imaging variables, opacification of spontaneous portosystemic shunt during TIPS placement but before its creation was associated with an increased risk of early complication (P=0.04). The other imaging variables were not associated with occurrence of complication.Identification of spontaneous portosystemic shunt during TIPS placement reflects the presence of varices and is associated with an increased risk of early severe complication.