Rebleeding rates following TIPS for variceal hemorrhage in the Viatorr era: TIPS alone versus TIPS with variceal embolization

Ron C. Gaba, James T. Bui, Scott J. Cotler, Eric R. Kallwitz, Olga T. Mengin, Brandon K. Martinez, Jaime L. Berkes, Tami C. Carrillo, M. Grace Knuttinen, Charles A. Owens

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

Purpose: To compare rebleeding rates following treatment of variceal hemorrhage with TIPS alone versus TIPS with variceal embolization in the covered stent-graft era. Methods: In this retrospective study, 52 patients (M:F 29:23, median age 52 years) with hepatic cirrhosis and variceal hemorrhage underwent TIPS insertion between 2003 and 2008. Median Child-Pugh and MELD scores were 8.5 and 13.5. Generally, 10-mm diameter TIPS were created using covered stent-grafts (Viatorr; W.L. Gore and Associates, Flagstaff, AZ). A total of 37 patients underwent TIPS alone, while 15 patients underwent TIPS with variceal embolization. The rates of rebleeding and survival were compared. Results: All TIPS were technically successful. Median portosystemic pressure gradient reductions were 13 versus 11 mmHg in the embolization and non-embolization groups. There were no statistically significant differences in Child-Pugh and MELD score, or portosystemic pressure gradients between each group. A trend toward increased rebleeding was present in the non-embolization group, where 8/37 (21.6%) patients rebled while 1/15 (6.7%) patients in the TIPS with embolization group rebled (P = 0.159) during median follow-up periods of 199 and 252 days (P = 0.374). Rebleeding approached statistical significance among patients with acute hemorrhage, where 8/32 (25%) versus 0/14 (0%) rebled in the non-embolization and embolization groups (P = 0.055). A trend toward increased bleeding-related mortality was seen in the non-embolization group (P = 0.120). Conclusions: TIPS alone showed a high incidence of rebleeding in this series, whereas TIPS with variceal embolization resulted in reduced recurrent hemorrhage. The efficacy of embolization during TIPS performed for variceal hemorrhage versus TIPS alone should be further compared with larger prospective randomized trials.

Original languageEnglish (US)
Pages (from-to)749-756
Number of pages8
JournalHepatology International
Volume4
Issue number4
DOIs
StatePublished - Dec 1 2010

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Keywords

  • Embolization
  • Rebleeding
  • Transjugular intrahepatic portosystemic shunt (TIPS)
  • Variceal hemorrhage

ASJC Scopus subject areas

  • Hepatology

Cite this

Gaba, R. C., Bui, J. T., Cotler, S. J., Kallwitz, E. R., Mengin, O. T., Martinez, B. K., Berkes, J. L., Carrillo, T. C., Knuttinen, M. G., & Owens, C. A. (2010). Rebleeding rates following TIPS for variceal hemorrhage in the Viatorr era: TIPS alone versus TIPS with variceal embolization. Hepatology International, 4(4), 749-756. https://doi.org/10.1007/s12072-010-9206-2