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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 10/2016

01-10-2016 | Clinical Investigation

Minilaparotomy-Assisted Transmesenteric-Transjugular Intrahepatic Portosystemic Shunt: Comparison with Conventional Transjugular Approach

Authors: Hamed Jalaeian, Reza Talaie, Donna D’Souza, Shayandokht Taleb, Siamak Noorbaloochi, Siobhan Flanagan, David Hunter, Jafar Golzarian

Published in: CardioVascular and Interventional Radiology | Issue 10/2016

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Abstract

Purpose

This study was performed to compare the intrahepatic shunt function outcome and procedural complications of minilaparotomy-assisted transmesenteric (MAT)-transjugular intrahepatic portosystemic shunt (TIPS) placement with the conventional transjugular method.

Methods

This is a retrospective review of all patients who had a MAT or conventional TIPS procedure over a 6-year period at our institute. The primary patency rate, fluoroscopy time, technical success, major procedure-related complications, and mortality data were compared between two treatment groups.

Results

We included 49 patients with MAT-TIPS, and 63 with conventional TIPS, with an average follow-up of 21.43 months. The primary patency rates at 6 and 12 months were 82.9 and 66.7 % in the conventional TIPS group, and 81.0 and 76.5 % in the MAT-TIPS group (p = 1.000, and 0.529), respectively. There was no significant difference in technical success rate, post-procedure portosystemic pressure gradient, fluoroscopy time, and peri-procedural mortality rate between treatment groups. Major procedural-related complications were seen more frequently among MAT-TIPS patients (p = 0.012). In the MAT-TIPS group, 5 (10.2 %) patients developed post-procedure minilaparotomy, wound-related complications, and 5 (10.2 %) developed bacterial peritonitis; whereas, none of patients with conventional TIPS had either of these complications (p = 0.014).

Conclusion

While both MAT-TIPS and conventional TIPS had similar shunt primary patency rate and technical success rate, the MAT approach was associated with a significantly higher rate of minilaparotomy-related wound complications or infectious complications. These complications maybe prevented by a change in post-procedure monitoring and therapy.
Literature
1.
Rosch J, Hanafee WN, Snow H. Transjugular portal venography and radiologic portacaval shunt: an experimental study. Radiology. 1969;92:1112–4.CrossRefPubMed
2.
Gordon JD, Colapinto RF, Abecassis M, Makowka L, Langer B, Blendis LM, Taylor B, Stronell RD. Transjugular intrahepatic portosystemic shunt: a nonoperative approach to life-threatening variceal bleeding. Can J Surg. 1987;30:45–9.PubMed
3.
Fidelman N, Kwan SW, LaBerge JM, Gordon RL, Ring EJ, Kerlan RK Jr. The transjugular intrahepatic portosystemic shunt: an update. AJR Am J Roentgenol. 2012;199:746–55.CrossRefPubMed
4.
Rozenblit G, DelGuercio LR, Savino JA, Rundback JH, Cerabona TD, Policastro AJ, Artuso DP. Transmesenteric-transfemoral method of intrahepatic portosystemic shunt placement with minilaparotomy. J Vasc Interv Radiol. 1996;7:499–506.CrossRefPubMed
5.
LaBerge JM, Ring EJ, Gordon RL. Percutaneous intrahepatic portosystemic shunt created via a femoral vein approach. Radiology. 1991;181:679–81.CrossRefPubMed
6.
Fitsiori K, Tsitskari M, Kelekis A, Filippiadis D, Triantafyllou K, Brountzos E. Transjugular intrahepatic portosystemic shunt for the treatment of Budd–Chiari syndrome patients: results from a single center. Cardiovasc Interv Radiol. 2014;37:691–7.CrossRef
7.
Gur I, Diggs BS, Orloff SL. Surgical portosystemic shunts in the era of TIPS and liver transplantation are still relevant. HPB (Oxford). 2014;16:481–93.CrossRef
8.
Haskal ZJ, Duszak R Jr, Furth EE. Transjugular intrahepatic transcaval portosystemic shunt: the gun-sight approach. J Vasc Interv Radiol. 1996;7:139–42.CrossRefPubMed
9.
Bercu ZL, Sheth SB, Noor A, Lookstein RA, Fischman AM, Nowakowski FS, Kim E, Patel RS. Percutaneous mesocaval shunt creation in a patient with chronic portal and superior mesenteric vein thrombosis. Cardiovasc Interv Radiol. 2015;38:1316–9.CrossRef
10.
Luo X, Ye L, Zhou X, Tsauo J, Zhou B, Zhang H, Zhang X, Li X. C-arm cone-beam volume CT in transjugular intrahepatic portosystemic shunt: initial clinical experience. Cardiovasc Interv Radiol. 2015;38:1627–31.CrossRef
11.
Gipson MG, Smith MT, Durham JD, Brown A, Johnson T, Ray CE Jr, Gupta RK, Kondo KL, Rochon PJ, Ryu RK. Intravascular US-guided portal vein access: improved procedural metrics during TIPS creation. J Vasc Interv Radiol. 2016. doi:10.​1016/​j.​jvir.​2015.​12.​002.
12.
Tsauo J, Luo X, Ye L, Li X. Three-dimensional path planning software-assisted transjugular intrahepatic portosystemic shunt: a technical modification. Cardiovasc Interv Radiol. 2015;38:742–6.CrossRef
13.
Rozenblit G, Del Guercio LR. Combined transmesenteric and transjugular approach for intrahepatic portosystemic shunt placement. J Vasc Interv Radiol. 1993;4:661–6.CrossRefPubMed
14.
Matsui O, Yoshikawa J, Kadoya M, Gabata T, Takashima T, Urabe T, Unoura M, Kobayashi K. Transjugular intrahepatic portosystemic shunt after previous recanalization of a chronically thrombosed portal vein via a transmesenteric approach. Cardiovasc Interv Radiol. 1996;19:352–5.CrossRef
15.
Qi X, Guo X, Fan D. A trend toward the improvement of survival after TIPS by the use of covered stents: a meta-analysis of two randomized controlled trials. Cardiovasc Interv Radiol. 2015;38:1363–4.CrossRef
16.
Pereira K, Carrion AF, Salsamendi J, Doshi M, Baker R, Kably I. Endovascular management of refractory hepatic encephalopathy complication of transjugular intrahepatic portosystemic shunt (TIPS): comprehensive review and clinical practice algorithm. Cardiovasc Interv Radiol. 2016;39:170–82.CrossRef
17.
Haskal ZJ, Rees CR, Ring EJ, Saxon R, Sacks D. Society of interventional radiology technology assessment C. Reporting standards for transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol. 2003;14:S419–26.CrossRefPubMed
18.
Weber CN, Nadolski GJ, White SB, Clark TW, Mondschein JI, William Stavropoulos S, Shlansky-Goldberg RD, Trerotola SO, Soulen MC. Long-term patency and clinical analysis of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunt stent grafts. J Vasc Interv Radiol. 2015;26(9):1257–65.
19.
Perarnau JM, Le Gouge A, Nicolas C, d’Alteroche L, Borentain P, Saliba F, Minello A, Anty R, Chagneau-Derrode C, Bernard PH, Abergel A, Ollivier-Hourmand I, Gournay J, Ayoub J, Gaborit C, Rusch E, Giraudeau B, group S-T. Covered vs. uncovered stents for transjugular intrahepatic portosystemic shunt: a randomized controlled trial. J Hepatol. 2014;60:962–8.CrossRefPubMed
20.
Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases: the role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Hepatology. 2005;41(2):386–400.CrossRefPubMed
21.
Ripamonti R, Ferral H, Alonzo M, Patel NH. Transjugular intrahepatic portosystemic shunt-related complications and practical solutions. Semin Interv Radiol. 2006;23:165–76.CrossRef
22.
Heinzow HS, Lenz P, Kohler M, Reinecke F, Ullerich H, Domschke W, Domagk D, Meister T. Clinical outcome and predictors of survival after TIPS insertion in patients with liver cirrhosis. World J Gastroenterol. 2012;18:5211–8.PubMedPubMedCentral
23.
Boyer TD, Haskal ZJ. American Association for the Study of Liver D. The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Hepatology. 2005;41:386–400.CrossRefPubMed
24.
Jirkovsky V, Fejfar T, Safka V, Hulek P, Krajina A, Chovanec V, Raupach J, Lojik M, Vanasek T, Renc O, Ali SM. Influence of the secondary deployment of expanded polytetrafluoroethylene-covered stent grafts on maintenance of transjugular intrahepatic portosystemic shunt patency. J Vasc Interv Radiol. 2011;22:55–60.CrossRefPubMed
Metadata
Title
Minilaparotomy-Assisted Transmesenteric-Transjugular Intrahepatic Portosystemic Shunt: Comparison with Conventional Transjugular Approach
Authors
Hamed Jalaeian
Reza Talaie
Donna D’Souza
Shayandokht Taleb
Siamak Noorbaloochi
Siobhan Flanagan
David Hunter
Jafar Golzarian
Publication date
01-10-2016
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 10/2016
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-016-1385-3

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