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Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy.
- Source :
-
World journal of gastroenterology [World J Gastroenterol] 2019 Mar 07; Vol. 25 (9), pp. 1088-1099. - Publication Year :
- 2019
-
Abstract
- Background: Transjugular intrahepatic portosystemic shunt (TIPS) is currently used for the treatment of complications of portal hypertension. The incidence of hepatic encephalopathy (HE) remains a problem in TIPS placement. It has been reported that the right branch mainly receives superior mesenteric venous blood while the left branch mainly receives blood from the splenic vein. We hypothesized that targeted puncture of the left portal vein would divert the non-nutritive blood from the splenic vein into the TIPS shunt; therefore, targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE.<br />Aim: To evaluate the influence of targeted puncture of left branch of portal vein in TIPS on HE.<br />Methods: A retrospective analysis of 1244 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2000 to January 2013 was performed. Patients were divided into group A (targeting left branch of portal vein, n = 937) and group B (targeting right branch of portal vein, n = 307). TIPS-related HE and clinical outcomes were analyzed.<br />Results: The symptoms of ascites and variceal bleeding disappeared within a short time. By the endpoint of follow-up, recurrent bleeding and ascites did not differ significantly between groups A and B ( P = 0.278, P = 0.561, respectively). Incidence of HE differed significantly between groups A and B at 1 mo (14.94% vs 36.80%, χ <superscript>2</superscript> = 4.839, P = 0.028), 3 mo (12.48% vs 34.20%, χ <superscript>2</superscript> = 5.054, P = 0.025), 6 mo (10.03% vs 32.24%, χ <superscript>2</superscript> = 6.560, P = 0.010), 9 mo (9.17% vs 31.27%, χ <superscript>2</superscript> = 5.357, P = 0.021), and 12 mo (8.21% vs 28.01, χ <superscript>2</superscript> = 3.848, P = 0.051). There were no significant differences between groups A and B at 3 years (6.61% vs 7.16%, χ <superscript>2</superscript> = 1.204, P = 0.272) and 5 years (5.01% vs 6.18%, χ <superscript>2</superscript> = 0.072, P = 0.562). The total survival rate did not differ between groups A and B ( χ <superscript>2</superscript> = 0.226, P = 0.634, log-rank test).<br />Conclusion: Targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE but has no direct influence on prognosis of portal-hypertension-related complications.<br />Competing Interests: Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study.
- Subjects :
- Adult
Ascites diagnosis
Ascites epidemiology
Ascites etiology
Esophageal and Gastric Varices diagnosis
Esophageal and Gastric Varices epidemiology
Esophageal and Gastric Varices etiology
Female
Hepatic Encephalopathy diagnosis
Hepatic Encephalopathy etiology
Humans
Hypertension, Portal etiology
Incidence
Male
Middle Aged
Prognosis
Retrospective Studies
Treatment Outcome
Young Adult
Hepatic Encephalopathy epidemiology
Hypertension, Portal surgery
Liver Cirrhosis complications
Portal Vein surgery
Portasystemic Shunt, Transjugular Intrahepatic methods
Subjects
Details
- Language :
- English
- ISSN :
- 2219-2840
- Volume :
- 25
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- World journal of gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 30862997
- Full Text :
- https://doi.org/10.3748/wjg.v25.i9.1088