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Abstract
Introduction: We aimed to assess whether Transjugular Intrahepatic Portosystemic Shunt (TIPS) creation via Peripheral Right Portal Vein access (P-RPV), which was considered the classic portal vein access site in TIPS creation, was associated with more severity of post-TIPS HE compared to the Other Portal Vein access (O-PV) which was named the modified portal vein access site.
Methods: This was an IRB-approved single-institution retrospective study. Consecutive patients with cirrhosis who underwent technically successful TIPS creation were reviewed. Patients were assigned to two groups: P-RPV group and O-PV group. The primary outcome was a clinically significant change in Hepatic Encephalopathy (ÎHE). Secondary outcomes included survival, stent patency, de novo HE, Overt HE (OHE, grades 2-4), rebleeding and ascites control. Predictors of significant ÎHE and overall survival were identified using Cox regression models.
Results: 328 patients were reviewed, and 230 patients were assigned to the P-RPV group (n=66) or the O-PV group (n=164). The incidence of ÎHE was 11 (17%), 14 (24%), 14 (25%) and 15 (30%) patients in the P-RPV group and 11 (8%), 13 (9%), 15 (12%) and 15 (12%) patients in the O-PV group at 30 days (p=0.03), 90 days (p=0.007), 180 days (p=0.03) and 365 days (p=0.005), respectively. P-RPV shunt location (HR, 3.11; 95% CI 1.35-7.14; p=0.008), HE before TIPS (HR, 2.47; 95% CI 1.10-5.55; p=0.03), TIPS patency (Year) (HR, 0.76; 95% CI 0.64-0.91; p=0.003) and 10 mm Viatorr stent-graft (HR, 0.09; 95% CI 0.20-0.44; p=0.003) were independently associated with significant ÎHE after TIPS. Our results did not show an association between survival and HE before TIPS (HR, 1.29; 95% CI 0.89-1.87; p=0.17).
Conclusion: TIPS with O-PV access may decrease significant ÎHE. The presence of HE before TIPS is associated with an increased risk of significant ÎHE after the procedure; however, it does not impact patient survival. Right atrial pressure after TIPS is a critical determinant of patient prognosis. Significant ÎHE may serve as a reliable indicator for evaluating HE following TIPS.
Google Scholar citation report
Citations : 1529
Journal of Infectious Diseases & Therapy received 1529 citations as per Google Scholar report
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