Efficacy of puncturing different portal vein branch during transjugular intrahepatic portosystemic shunt with 8 mm covered stent: a propensity-score analysis

Portal flow diversion based on portography is superior than puncture site in the prediction of overt hepatic encephalopathy after TIPS creation

Background

Targeted puncture of an appropriate portal venous branch during transjugular intrahepatic portosystemic shunt (TIPS) procedure may reduce the risk of postprocedural overt hepatic encephalopathy (HE). This study aimed to describe blood distribution under portography and combined it with puncture site to determine portal flow diversion, and to evaluate its prognostic value in predicting post-TIPS overt HE.

Methods

In this retrospective analysis of patients with cirrhosis undergoing TIPS, we included 252 patients to describe blood distribution under portography and 243 patients to assess the association between portal flow diversion and post-TIPS overt HE.

Results

At the first stage, 51 (20.2%) patients were identified as type A (unilateral type with the right portal branch receives blood from splenic vein [SV]), 16 (6.4%) as type B (unilateral type with the right branch receives blood from superior mesenteric vein [SMV]) and 185 (73.4%) as type C (fully mixed type). At the second stage, 40 patients were divided into the SV group, 25 into the SMV group and 178 into the mixed group. Compared with the mixed group, the risk of post-TIPS overt HE was significantly higher in the SMV group (adjusted HR 3.70 [95% CI 2.01–6.80]; p < 0.001), whereas the SV group showed a non-significantly decreased risk (adjusted HR 0.57 [95% CI 0.22–1.48]; p = 0.25). Additionally, the SMV group showed a substantial increase in ammonia level at 3 days and 1 month after procedure.

Conclusions

Our results support the clinical use of portal flow diversion for risk stratification and decision-making in the management of post-TIPS overt HE.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-022-02447-y.

Clinical efficacy of transjugular intrahepatic portosystemic shunt created through left or right branches of the portal vein: A meta-analysis

Background and aim

Transjugular intrahepatic portosystemic shunt (TIPS) is a technique successfully used to treat portal hypertension and its complications. However, the choice of the branch, left (L) or right (R), of the portal vein resulting in a better outcome is still under debate. Therefore, this meta-analysis aims to evaluate which branch has a better curative effect on patients treated with TIPS.

Methods

PubMed, EMBASE, Web of science, Cochrane Library databases, Wanfang database and CBM were used for our search in October 2019 and updated in June 2021. The following parameters were used in evaluation: overall mortality, hepatic encephalopathy, shunt dysfunction, variceal rebleeding and rate of postoperative ascites.

Results

There were seven studies included. The sample size was 1940. A lower risk of mortality was observed in TIPS-L-treated patients compared with TIPS-R-treated ones (OR ​= ​0.65, 95% CI ​= ​0.50–0.85, p ​= ​0.002). A lower risk of shunt dysfunction was observed in TIPS-L-treated patients compared with TIPS-R-treated ones (OR ​= ​0.53, 95% CI ​= ​0.33–0.87, p ​= ​0.01). And the TIPS-L group had a significantly higher hepatic encephalopathy-free rate than the TIPS-R group (OR ​= ​0.59, 95% CI ​= ​0.44–0.78, p ​= ​0.0002). However, the rate of rebleeding (OR ​= ​0.75, 95% CI ​= ​0.55–1.03, p ​= ​0.07) and incidence of postoperative ascites (OR ​= ​1.14, 95% CI ​= ​0.86–1.51, p ​= ​0.38) was not statistically significant between the two groups.

Conclusions

Based on the currently available evidence, the technique of TIPS through the left branch of the portal vein can significantly reduce the occurrence of overall postoperative mortality, hepatic encephalopathy and shunt dysfunction.