Outcomes of transjugular intrahepatic portosystemic shunt using 12 mm diameter stent for portal hypertension with variceal bleeding

Congress:

ECR 2018

Poster Number:

C-0472

Type:

Scientific Exhibit

Keywords:

Interventional vascular, Liver, CT-Angiography, Shunts, Cirrhosis

Authors:

A. M. K. Abdel Aal, K. Mahmoud, S. Kim, B. Heeke, N. Ertel, S. Moawad, M. Massoud, S. Saddekni, A. Gunn; BIRMINGHAM, AL/US

DOI:

10.1594/ecr2018/C-0472

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-0472

Fig. 2: Fluoroscopic image demonstrating satisfactory placement of a 12 mm Viatorr Stent

Fig. 1: Fluoroscopic image showing ballooning a 12 mm TIPS stent with a 10 mm balloon...

Fig. 3: Axial CT image demonstrating a deployed 12 mm TIPS stent in a cirrhotic patient...

Table 1: Demographics Information of our TIPS Patients with Variceal Bleeding.

Table 3: Hepatic Encephalopathy Rates in our TIPS patients with Variceal Bleeding

Fig. 4: Survival Curve for our TIPS Patients with Variceal Bleeding

Aims and objectives

Evaluate the efficacy and survival outcomes of transjugular intrahepatic portosystemic shunt (TIPS) creation using a 12-mm diameter Viatorr stent (Gore, Newark, DE) in cirrhotic patients with portal hypertension and variceal bleeding ( Fig. 1), ( Fig. 2 ) and ( Fig. 3 ).

Methods and materials

Retrospective review of 173 patients who underwent TIPS for bleeding varices from January 2004 to February 2017 using 12 mm Viatorr stent. Patients' demographics, comorbidities, Model for End-stage Liver Disease (MELD) score, occurrence of re-bleeding, incidence or worsening of hepatic encephalopathy (HE) and the need for TIPS revision were recorded. Survival outcomes were calculated.

Results

The study included 113 (65.3%) males and 60 females (34.7%) with a mean age of 56.5 years (SD 10.6). The mean Charlson Index for patients' comorbidities was 3.8 (SD 1.0). Mean MELD score increased significantly from 12.1 to 15.5 (p<0.0001) ( Table 1 ). Re-bleeding rate after successful TIPS at 3, 6, and 12 months was 3.96%, 11.95%, and 12.94% respectively ( Table 2 ). Before TIPS, hepatic encephalopathy (HE) was documented in 11.2% of the patients. At 3, 6, and 12 months after TIPS,...

Conclusion

12 mm Viatorr stents are without increased complication rate and at least as efficacious for variceal bleeding compared to 8 and 10mm stents.

Personal information

Ahmed Kamel Abdel Aal , MD,PhD, FSIR University of Alabama at Birmingham (UAB). Department of Radiology. Division ofInterventional Radiology. United States , Alabama. Address: 619 19th Street South, Birmingham, AL 35249. Tel:(205) 975-4850 Fax: (205) 975-5257 Email:[email protected] Twitter: ahmed_kamel_ir

References

1. Riggio, et al. Clinical efficacy of transjugular intrahepatic portosystemic shunt created with covered stents with different diameters: Results of a randomized controlled trial. Journal of Hepatology 2010 vol. 53; 267–272. 2. Kuhn-Fulton, et al. Transjugular Intrahepatic Portosystemic Shunt Procedure: Efficacy of 10mm vs 12mm Wallstents. Radiology 1996, 199:658-664. 3. Miraglia, et al Transjugular Intrahepatic Portosystemic Shunts in Patients with Cirrhosis with Refractory Ascites: Comparison of Clinical Outcomes by using 8- and 10-mm PTFE covered Stents. Radiology2017284:1,281-288 4. Gaba, et al. TIPS for Treatment of...