Article Text

PDF

PWE-122 Parallel Tipss for the Management of Shunt Insufficiency in Patients with Complications of Portal Hypertension: A Tertiary Liver Unit 19 Year Experience
  1. N Rajoriya1,
  2. H Merzhat2,
  3. K Mangat2,
  4. S Oliff2,
  5. D Tripathi1
  1. 1Liver Medicine
  2. 2Radiology, The New Queen Elizabeth Hospital, Birmingham, UK

Abstract

Introduction Transjugular Intrahepatic Porto-Systemic Shunts (TIPSS) insufficiency can be addressed with a side placement of another TIPSS beside the original (“parallel” technique) thus improving portosystemic pressure gradient (PPG). There is a paucity of data assessing the efficacy of this technique.

The Aim of this study was to assess the efficacy of parallel TIPSS in a large UK tertiary referral centre.

Methods A retrospective study was performed from patient electronic databases. Parallel TIPSS were performed over a 19 year period.

Results 11 patients (8M:3F) were identified (2% of all TIPSS procedures). Mean age at time of parallel TIPSS was 48.6(+/-13.7). Background aetiology of portal hypertension included: 5 ALD, 2 PSC, 2 PBC, 1 liver graft failure, 1 NCPH. Indications for index TIPSS (5 covered stents) were: 4 Oesophageal variceal (OV) haemorrhage, 3 gastric variceal (GV) haemorrhage, 1 stromal variceal haemorrhage and 3 for refractory ascites. At time of 1st TIPSS, documented mean PPG was 16.6(+/-7.71) and post TIPSS 10.8(+/-7.35) mmHg. Median time between index TIPSS and parallel TIPSS insertion was 72 days (IQR 4–1122 days). Prior to parallel stent placement, 7 patients had dilatation of the index TIPSS.

At parallel TIPSS, the mean initial PPG was 16.0 (+/-7.40)/post procedure 6 (+/-2.28) mmHg. 63% had covered stent as the parallel TIPSS. One patient had transient encephalopathy, but no other complications were encountered. Nine patients had a resolution in symptoms. One patient had ongoing GV bleeding requiring Thrombin injection and 1 patient had ascites with no flow in parallel TIPSS 4 days post-procedure. Secondary patency was 82% with a median number of interventions of 1.5 (IQR 1–3).

Median follow-up was 30 months (range 0.5–120). 92% patients were alive at 1 month with 86% 1 year survival. Two patients were transplanted during follow-up.

Conclusion Parallel TIPSS is a safe and effective method to treat TIPSS insufficiency. The majority of patients not only had a good haemodynamic result, but also resolution of symptoms.

Disclosure of Interest None Declared.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.