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Al-Balas H, Vyas A. Percutaneous Endovascular Management of a Splenic Vein Pseudoaneurysm Secondary to Pancreatic Pseudocyst. J Endovasc Ther 2023:15266028231213043. [PMID: 37997368 DOI: 10.1177/15266028231213043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
CLINICAL IMPACT This case report sheds light on a rare complication of pancreatitis, splenic vein pseudoaneurysm. The pseudoaneurysm was successfully treated percutaneously using a covered stent. The article also emphasizes the utilization and safety of transhepatic approach to interventions related to portal vein and its tributaries.
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Affiliation(s)
- Hassan Al-Balas
- Department of Radiology, Jordan University of Science and Technology, Irbid, Jordan
| | - Ajit Vyas
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
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Cannataci C, Cimo' B, Mamone G, Tuzzolino F, D'Amico M, Cortis K, Maruzzelli L, Miraglia R. Portal vein puncture-related complications during transjugular intrahepatic portosystemic shunt creation: Colapinto needle set vs Rösch-Uchida needle set. Radiol Med 2021; 126:1487-1495. [PMID: 34405340 DOI: 10.1007/s11547-021-01404-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023]
Abstract
Transjugular portal vein puncture is considered the riskiest step in TIPS creation with possible incidence of portal vein puncture-related complications (PVPC). The Colapinto and the Rösch-Uchida needle sets are two different needle sets currently available. To date, there have been no randomized control trials or systematic reviews which compare the incidence of PVPC when using the two different needle sets. The aim of this literature review is to assess the rate of PVPC associated with the different needle sets used in the creation of TIPS. From the described search, 1500 articles were identified and 34 met the inclusion criteria. Outcome measured was the prevalence of PVPC using the different needle sets. Overall 212 (3.6%) PVPC were reported in 5865 patients; 142 (3.5%) reported in 4000 cases using the Rösch-Uchida set and 70 (3.7%) in 1865 patients using the Colapinto set (p = 0.69). PVPC in TIPS creation are not related to the choice of needle set used in the procedure. To our knowledge, this is the first review of its kind, the results of which support the theory that while the rate of PVPC is influenced by many factors, choice of needle set does not seem to be one of them.
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Affiliation(s)
| | - Biagio Cimo'
- Radiology Institute, Department of Medicine - DIMED, University of Padua, Padova, Italy
| | - Giuseppe Mamone
- Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), via Tricomi 5, 90127, Palermo, Italy.
| | - Fabio Tuzzolino
- Research Office, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Mario D'Amico
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia- Cervello, Palermo, Italy
| | - Kelvin Cortis
- Medical Imaging Department, Mater Dei Hospital, Msida, Malta
| | - Luigi Maruzzelli
- Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), via Tricomi 5, 90127, Palermo, Italy
| | - Roberto Miraglia
- Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), via Tricomi 5, 90127, Palermo, Italy
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MELD or Sodium MELD: A Comparison of the Ability of Two Scoring Systems to Predict Outcomes After Transjugular Intrahepatic Portosystemic Shunt Placement. AJR Am J Roentgenol 2020; 215:215-222. [DOI: 10.2214/ajr.19.21726] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Perello MP, Mur JP, Vives MS, Riutort JMM, Artigues AP, Garcia CN, Vidal MLB, Gelabert AE, Garau MV. Long-term follow-up of transjugular intrahepatic portosystemic shunt (TIPS) with stent-graft. ACTA ACUST UNITED AC 2020; 25:346-352. [PMID: 31322502 DOI: 10.5152/dir.2019.18416] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE We aimed to retrospectively evaluate the long-term clinical and patency results after the placement of transjugular intrahepatic portosystemic shunts (TIPS) using stent-graft. Many studies show the clinical results and the patency follow-up of TIPS with stent-graft in the short and medium term. However, few studies show long-term results. METHODS Between 2002 and 2016, TIPS with stent-grafts were placed in 132 patients. The median age was 59.5 years. The median Model for End-stage Liver Disease (MELD) score was 13, and 71% were Child-Pugh B. Indications for TIPS were bleeding (83%) and ascites or hydrothorax (17%). The technical and clinical success rates were calculated, as were the rates of patency, survival and complications. The median follow-up period was 43 months. RESULTS The technical success rate was 98%, and the clinical success rates were 85% in patients with indication for bleeding and 95% in patients with indication for ascites or hydrothorax. Primary patency did not decrease from 66% after 6 years (95% confidence interval [CI], 56.2%-75.8%) primary assisted patency remained stable at 87% after 6 years (95% CI, 77.2%-96.8%) and secondary patency did not decrease from 98% after 4 years (95% CI, 95.1%-100%). The median overall survival was 42.8 months (95% CI, 33.8-51.8 months). A total of 54 patients suffered some type of complication, minor (28 patients) or major (26 patients), during the follow-up. CONCLUSION The clinical success rate was high. The choice of the maximum initial limit of portosystemic gradient and the diameter of the post-TIPS shunt, together with the number of shunt reductions, are important to be able to compare results between publications. In our study, the patency rates did not decrease after 6 years; hence, long-term follow-up of these patients may not be necessary.
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Affiliation(s)
| | - Javier Pueyo Mur
- Department of Radiology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | | | - Carolina Nieto Garcia
- Department of Radiology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | - Ana Escarda Gelabert
- Department of Gastroenterology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Long-term shunt patency and overall survival of transjugular intrahepatic portosystemic shunt placement using covered stents with bare stents versus covered stents alone. Clin Radiol 2018; 73:580-587. [PMID: 29475551 DOI: 10.1016/j.crad.2018.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/19/2018] [Indexed: 12/24/2022]
Abstract
AIM To investigate the long-term shunt patency and overall survival of transjugular intrahepatic portosystemic shunt (TIPS) placement using covered stents with or without bare stents over a follow-up period up to 7 years. MATERIALS AND METHODS A total of 154 patients undergoing TIPS placement were enrolled and analysed retrospectively. They were divided into two groups: those undergoing TIPS placement using covered with bare stents (group A, n=42) and those without bare stents (group B, n=112). RESULTS The cumulative 5-year primary patency rate was significantly lower in group A than in group B (group A: 0% versus group B: 66.7%; p<0.001). The cumulative 5-year overall survival rates were comparable between the two groups (group A: 76% versus group B: 58.7%; p=0.214). The baseline portal vein thrombosis (hazard ratio [HR]:4.610; 95% confidence interval [CI]:2.691-7.897; p=0.000), portal pressure decrement (HR: 0.911; 95% CI: 0.845-0.982; p=0.015), and group (HR: 0.419; 95% CI: 0.239-0.736; p=0.002) were independent predictors for shunt dysfunction, while hepatocellular carcinoma (HR: 6.615; 95% CI: 2.863-15.283; p=0.000) and ascites (HR: 2.166; 95% CI: 1.298-3.615; p=0.003) were independent predictors for mortality. CONCLUSIONS Although TIPS placement using covered with bare stents led to lowered long-term shunt patency than using covered stents alone, the overall survival rates were similar.
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Triantafyllou T, Aggarwal P, Gupta E, Svetanoff WJ, Bhirud DP, Singhal S. Polytetrafluoroethylene-Covered Stent Graft Versus Bare Stent in Transjugular Intrahepatic Portosystemic Shunt: Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2018; 28:867-879. [PMID: 29356589 DOI: 10.1089/lap.2017.0560] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND & AIMS Transjugular Intrahepatic Portosystemic Shunt (TIPS) is used to control refractory variceal bleeding secondary to portal hypertension. This meta-analysis was conducted to systematically review polytetrafluoroethylene-covered stent grafts (CS) versus bare stents (BS) in TIPS procedure. METHODS Systematic search of literature databases was done from January-1990 till April-2017, using predecided keywords. Outcome measures studied were (1) primary-patency (PP) at 1 year (defined as absence of shunt insufficiency at 1 year), (2) rebleeding (RE) (3) new-onset hepatic encephalopathy ([HE] new-onset or worsening encephalopathy following the procedure), and (4) survival at 1 year (SU). Odds ratio (OR) was calculated for each outcome variable. Between-study heterogeneity was assessed by the I2 statistics and χ2 Q-test. RESULTS Fourteen studies (4 RCTs, 2 prospective nonrandomized, and 8 retrospective) were included with 2519 patients (1548 patients in BS group and 971 patients in CS group). Three-quarter outcome measures showed significantly better results with CS. PP was pooled from 13 studies and showed an OR = 4.75 (95% confidence interval [CI] = 3.32-6.79; P < .00001; I2 = 44%) in favor of CS. RE was pooled from six studies with odds ratio (OR) = 0.37(95% CI = 0.24-0.56; P < .00001; I2 = 0%) in favor of CS. SU was pooled from 11 studies with OR = 1.85 (95% CI = 1.44-2.38; P < .00001; I2 = 0%) in favor of CS. On subset analysis for RCTs, three outcome variables favored CS with minimal heterogeneity [PP: OR = 4.18 (95% CI = 2.66-6.55; P < .00001; I2 = 0%). RE: OR = 0.43 (95% CI = 0.25-0.72; P < .001; I2 = 0%). SU: OR = 1.85 (95% CI = 1.44-2.38, P < .00001; I2 = 0%)]. HE showed no difference between two stents on the overall and subset pooled analysis. Overall: OR = 0.86 (95% CI = 0.68-1.08; P = .19; I2 = 4%). Only RCTs: OR = 0.91 (95% CI = 0.63-1.32, P = .63; I2 = 0%). CONCLUSIONS CS is associated with better primary patency and survival and lesser rate of rebleeding than BS in patients undergoing TIPS procedure. There is no difference in new-onset hepatic encephalopathy.
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Affiliation(s)
| | - Piyush Aggarwal
- 2 All India Institute of Medical Sciences , New Delhi, India
| | - Ekansh Gupta
- 2 All India Institute of Medical Sciences , New Delhi, India
| | - Wendy Jo Svetanoff
- 3 Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
| | | | - Saurabh Singhal
- 5 St. Joseph's Hospital and Medical Centre , Phoenix, Arizona
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Buechter M, Manka P, Gerken G, Canbay A, Blomeyer S, Wetter A, Altenbernd J, Kahraman A, Theysohn JM. Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist's Experience. Dig Dis 2018; 36:218-227. [PMID: 29316565 DOI: 10.1159/000486030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in decompensated portal hypertension. TIPS revision due to thrombosis or stenosis increases morbidity and mortality. Our aim was to investigate patient- and procedure-associated risk factors for TIPS-revision. PATIENTS AND METHODS We retrospectively evaluated 189 patients who underwent the TIPS procedure. Only patients who required TIPS revision within 1 year (Group I, 34 patients) and patients who did not require re-intervention within the first year (Group II [control group], 54 patients) were included. RESULTS Out of 88 patients, the majority were male (69.3%) and mean age was 56 ± 11 years. Indications for TIPS were refractory ascites (68%), bleeding (24%), and Budd-Chiari syndrome (8%). The most frequent liver disease was alcohol-induced cirrhosis (60%). Forty-three patients (49%) received bare and 45 patients (51%) covered stents, thus resulting in reduction of hepatic venous pressure gradient (HVPG) from 19.0 to 9.0 mm Hg. When comparing patient- and procedure-related factors, the type of stent (p < 0.01) and interventionalist's experience (number of performed TIPS implantations per year; p < 0.05) were the only factors affecting the risk of re-intervention due to stent dysfunction, while age, gender, indication, Child-Pugh, and model of end-stage liver disease score, platelet count, pre- and post-HVPG, additional variceal embolization, stent diameter, and number of stents did not significantly differ. CONCLUSION Patients undergoing TIPS procedure should be surveilled closely for shunt dysfunction while covered stents and high-level experience are associated with increased -patency.
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Affiliation(s)
- Matthias Buechter
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Paul Manka
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany.,Regeneration and Repair, Institute of Hepatology, Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Ali Canbay
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - Sandra Blomeyer
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Axel Wetter
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Jens Altenbernd
- Department of Radiology and Neuroradiology, Klinikum Vest Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Alisan Kahraman
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Jens M Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Incrementally Expandable Transjugular Intrahepatic Portosystemic Shunts: Single-Center Experience. AJR Am J Roentgenol 2017; 210:438-446. [PMID: 29261352 DOI: 10.2214/ajr.17.18222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study is to investigate the long-term safety and efficacy of a small-diameter expandable transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension. MATERIALS AND METHODS This single-center retrospective study included 28 patients (12 women and 16 men; mean age, 56.9 years) who underwent small-diameter expandable TIPS creation between 2008 and 2010 for refractory ascites (n = 15; mean [± SD] model for end-stage liver disease [MELD] score, 15.5 ± 5.3) or gastrointestinal variceal bleeding (n = 13; mean MELD score, 15.2 ± 8.4). An expandable TIPS was created by deploying a covered stent inside a balloon expandable stent. For patients with recurrent symptoms, TIPS adjustment was made by balloon expandable stent balloon dilation. The TIPS diameter was defined as the diameter of the final angioplasty balloon. TIPS patency and efficacy and the rate of post-TIPS hepatic encephalopathy were evaluated. RESULTS The median diameter of the initial TIPS was 8 mm in the group with variceal bleeding compared with 6 mm in the group with ascites (p = 0.003). The primary patency rate at 1 and 5 years was 90.8% and 73.3%, respectively. Eighty percent of patients with ascites required no or less-frequent large-volume paracentesis. The clinical success rate for patients with acute variceal bleeding was 92.3%. Six patients with ascites (initial TIPS diameter, 6 mm) and two patients with variceal bleeding (initial diameter, 6 mm and 8 mm) required subsequent TIPS adjustment. Of the 22 patients with no prior history of enecphalophy, seven patients (31.8%) experienced new hepatic encephalopathy within 90 days. CONCLUSION A small-diameter expandable TIPS is technically feasible and safe, with efficacy falling within the range of that of conventional TIPS. This technique offers the possibility of individualizing the degree of portal decompression.
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Gupta AC, Wang W, Shah C, Sands MJ, Bullen J, Remer EM, Bayona PM, Carey W, Kapoor B. Added Value of Covered Stents in Transjugular Intrahepatic Portosystemic Shunt: A Large Single-Center Experience. Cardiovasc Intervent Radiol 2017; 40:1723-1731. [PMID: 28512687 DOI: 10.1007/s00270-017-1694-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/08/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE Transjugular intrahepatic portosystemic shunts (TIPS) were historically placed using uncovered bare-metal stents. Current practice has now shifted toward the use of polytetrafluoroethylene (PTFE)-covered stents, given the improved primary patency seen with these stents. The aim of this study was to determine whether there is any added value, such as overall survival or stent patency, when using covered stents versus uncovered stents in TIPS placement in a large cohort. MATERIALS AND METHODS From April 1995 to June 2012, a total of 744 consecutive adult patients underwent de novo TIPS placement (378 receiving uncovered stents, 366 receiving covered stents). Information was obtained on demographics, baseline clinical variables, and outcomes after TIPS placement. Data were collected, compared, and analyzed to assess outcomes including mortality, primary patency (determined via repeat intervention), and secondary patency (determined via ultrasound parameters). RESULTS Covered stents were associated with significantly improved primary patency (P < 0.001) and secondary patency (P < 0.001) when compared with uncovered stents in TIPS procedures. Additionally, covered stents were associated with higher estimated overall survival rates and higher survival rates when TIPS was performed emergently and in patients with higher Model for End-Stage Liver Disease (MELD) scores. For example, in patients with MELD scores between 11 and 18, there was a predicted survival of 59.2% with covered stents versus 42.8% with uncovered stents at 1 year. CONCLUSION This study demonstrated that covered stents offer the additional value of higher estimated overall survival and higher estimated survival in patients undergoing TIPS emergently and in those with higher MELD scores when compared to uncovered stents.
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Affiliation(s)
- Amar C Gupta
- Department of Vascular and Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA.
| | - Weiping Wang
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Chintan Shah
- Department of Diagnostic Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Sands
- Department of Vascular and Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer Bullen
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Erick M Remer
- Department of Abdominal Imaging, Cleveland Clinic, Cleveland, OH, USA
| | - Pilar M Bayona
- Department of Vascular and Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - William Carey
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Baljendra Kapoor
- Department of Vascular and Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA
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