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European Radiology
Published in: European Radiology 9/2019

01-09-2019 | Portal Vein Thrombosis | Interventional

Comparison of TIPS alone and combined with partial splenic embolization (PSE) for the management of variceal bleeding

Authors: Yue-Meng Wan, Yu-Hua Li, Zhi-Yuan Xu, Hua-Mei Wu, Xi-Nan Wu, Ying Xu

Published in: European Radiology | Issue 9/2019

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Abstract

Objectives

Transjugular intrahepatic portosystemic shunt (TIPS) and partial splenic embolization (PSE) were two interventional radiological treatments for the complications of cirrhosis. This study aimed to investigate the effects of concomitant PSE on the long-term shunt patency and overall survival of TIPS-treated patients.

Methods

Forty-eight patients with TIPS insertion were enrolled and studied retrospectively. They were divided into TIPS+PSE (n = 16) and TIPS groups (n = 32), undergoing combined therapy using TIPS and PSE, and monotherapy using TIPS alone, respectively.

Results

The 5-year cumulative primary patency rate in the TIPS+PSE group was markedly higher than in the TIPS group (56.8% vs. 32.8%, p = 0.028), whereas the 5-year cumulative secondary patency rate (93.8% vs. 87.7%, p = 0.749) and overall survival rate (62.5% vs. 30.7%, p = 0.414) were not significantly different between the two groups. Cox-regression models revealed that group (hazard ratio [HR], 0.235; 95% CI, 0.084–0.665; p = 0.006), portal venous pressure decline (HR, 0.687; 95% CI, 0.563–0.838; p = 0.000), and baseline portal vein thrombosis (HR, 3.955; 95% CI, 1.634–9.573; p = 0.002) were significant predictors for shunt dysfunction, while only ascites (HR, 2.941; 95% CI, 1.250–6.920; p = 0.013) was a significant predictor for mortality. No severe adverse event was noted in the two groups except for the potential risk of splenic abscess development in the TIPS+PSE group.

Conclusions

Concomitant PSE may help increase the long-term primary shunt patency rate, but not the overall survival of TIPS-treated patients. Further prospective studies are needed to validate these retrospective findings and to investigate the potential mechanisms.

Key Points

• Combined therapy using TIPS and PSE is associated with higher primary patency rates than TIPS alone.
• Combined therapy using TIPS and PSE is associated with similar rates of secondary patency and overall survival of patients than TIPS alone.
• Group (TIPS alone or TIPS+PSE), PVD, and baseline PVT are three independent predictors for shunt dysfunction, while ascites is the only independent predictor for mortality.
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Metadata
Title
Comparison of TIPS alone and combined with partial splenic embolization (PSE) for the management of variceal bleeding
Authors
Yue-Meng Wan
Yu-Hua Li
Zhi-Yuan Xu
Hua-Mei Wu
Xi-Nan Wu
Ying Xu
Publication date
01-09-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06046-6

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