TIPS for treatment of variceal hemorrhage: Clinical outcomes in 128 patients at a single institution over a 12-year period

Ron C. Gaba, Benedictta O. Omene, Elizabeth S. Podczerwinski, M. Grace Knuttinen, Scott J. Cotler, Eric R. Kallwitz, Jaime L. Berkes, Natasha M. Walzer, James T. Bui, Charles A. Owens

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Abstract

Purpose: To assess clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) treatment of variceal hemorrhage. Materials and Methods: A total of 128 patients (82 men and 46 women; mean age, 52 y) with liver cirrhosis and refractory variceal hemorrhage underwent TIPS creation from 1998 to 2010. Mean Child-Pugh and Model for End-stage Liver Disease (MELD) scores were 9 and 18, respectively. From 1998 to 2004, 12-mm Wallstents (n = 58) were used, whereas from 2004 to 2010, 10-mm VIATORR covered stent-grafts (n = 70) were used. Technical success, hemodynamic success, complications, shunt dysfunction, recurrent bleeding, and overall survival were assessed. Results: Technical and hemodynamic success rates were 100% and 94%, respectively. Mean portosystemic gradient reduction was 13 mm Hg. Complications at 30 days included encephalopathy (14%), renal failure (5.5%), infection (1.6%), and liver failure (0.8%). Shunt patency rates were 93%, 82%, and 60% at 30 days, 1 year, and 2 years, respectively. Dysfunction, or loss of TIPS primary patency, occurred more with Wallstent versus VIATORR TIPSs (29% vs 11%; P =.009). Recurrent bleeding incidences were 9%, 22%, and 29% at 30 days, 1 year, and 2 years, respectively, and were similar between Wallstent and VIATORR TIPSs (19% vs 19%; P =.924). Variceal embolization significantly reduced recurrent bleeding rates (5% vs 25%; P =.013). Overall survival rates were 80%, 69%, and 65% at 30 days, 1 year, and 2 years, respectively, and were similar between Wallstent and VIATORR TIPSs (35% vs 26% mortality rate; P =.312). Advanced MELD score was associated with increased mortality on multivariate analysis. Conclusions: Wallstent and VIATORR TIPSs effectively treat variceal hemorrhage, particularly when accompanied by variceal embolization. Although TIPS with a VIATORR device showed improved shunt patency, patient survival is similar to that with Wallstent TIPS. These results further validate TIPS creation for refractory variceal bleeding.

Original languageEnglish (US)
Pages (from-to)227-235
Number of pages9
JournalJournal of Vascular and Interventional Radiology
Volume23
Issue number2
DOIs
StatePublished - Feb 1 2012

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Gaba, R. C., Omene, B. O., Podczerwinski, E. S., Knuttinen, M. G., Cotler, S. J., Kallwitz, E. R., Berkes, J. L., Walzer, N. M., Bui, J. T., & Owens, C. A. (2012). TIPS for treatment of variceal hemorrhage: Clinical outcomes in 128 patients at a single institution over a 12-year period. Journal of Vascular and Interventional Radiology, 23(2), 227-235. https://doi.org/10.1016/j.jvir.2011.10.015