1,000 TIPS in UH Hradec Kralove: indications and surviving

Česká verzia

Authors: Š. Šembera ¹; V. Jirkovský ¹; A. Krajina ²; T. Fejfar ¹; J. Žižka ²; V. Chovanec ²; Miroslav Lojík ² ; J. Raupach ²; V. Šafka ²; T. Vaňásek ²; O. Renc ²; P. Hůlek ^1,3
Authors place of work: Interní gastroenterologická klinika LF UK a FN Hradec Králové ¹; Radiologická klinika LF UK a FN Hradec Králové ²; Interní klinika LF OU, Ostrava ³
Published in the journal: Gastroent Hepatol 2014; 68(2): 108-115
Category: Hepatology: Original Article

Summary

A total of 1,000 transjugular intrahepatic portosystemic shunts were performed at the University Hospital in Hradec Kralove during the period between September 1992 and February 2014. The cohort consisted of 651 males and 349 females, and the mean age was 54.9, ranging from 4.2 to 83.1 years. The procedure was most often performed in patients with liver cirrhosis due to portal hypertension complications (927 cases) and Budd-Chiari syndrome (52 cases). The procedure was unsuccessful in five cases. The most common indications for TIPS were: stopping oesophageal or gastric bleeding which could not be terminated by other methods (196 cases), prevention of recurrent variceal bleeding (371 cases) and treatment of refractory or intractable ascites (288 cases). Complications resulting in death of the patient during the procedure occurred in five cases. One-month and one-year survival in cirrhotic patients was 88% and 67%; in patients with Child-Pugh A classification 98% and 84%; Child-Pugh B classification 92% and 67%; Child-Pugh C classification 77% and 52%; in patients with bleeding which could not be terminated by other methods it was 80% and 64%; in patients indicated to prevent rebleeding 95% and 76%; and for treatment of ascites it was 86% and 54% respectively. TIPS became a standard method for treatment of complications related to portal hypertension in cirrhotic patients. During its 21 years of use in our centre, the proportion of indications as well as the structure of the cohort of patients is gradually changing.

Key words:
ascites – liver cirrhosis – Kaplan-Meier estimate – portal hypertension – portosystemic shunt – transjugular intrahepatic

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
21. 2. 2014

Accepted:
24. 3. 2014

Zdroje

1. Rösch J, Hanafee WN, Snow H. Transjugular portal venography and radiologic portacaval shunt: an experimental study. Radiology 1969; 92(5): 1112–1114.

2. Richter GM, Palmaz JC, Nöldge G et al. The transjugular intrahepatic portosystemic stent-shunt. A new nonsurgical percutaneous method. Radiologe 1989; 29(8): 406–411.

3. Krajina A, Hůlek P, Eliáš P et al. Transjugulární intrahepatální portosystémový zkrat (TIPS) při léčbě symptomatické portální hypertenze. Čas Lék Čes 1996; 135: 584–588.

4. Krajina A, Hůlek P, Eliáš P et al. Transjugulární intrahepatický portosystémový zkrat. Cor Vasa 1993; 35(4): 157–161.

5. Krajina A. Dvacetiletá historie TIPS v Hradci Králové. Ces Radiol 2013; 67(2): 105–108.

6. Lojík M, Krajina A, Vaňásek T et al. Embolizace krvácejících varixů při portální hypertenzi u TIPS – vlastní zkušenosti a literární přehled. Ces Radiol 2002; 56(3): 188–192.

7. Krajina A, Hulek P, Fejfar T et al. Quality improvement guidelines for Transjugular Intrahepatic Portosystemic Shunt (TIPS). Cardiovasc Intervent Radiol 2012; 35(6): 1295–1300. doi: 10.1007/s00270-012-0493-y.

8. Jirkovský V, Hůlek P, Fejfar T et al. Dysfunkce transjugulární intrahepatální portosystémové spojky (TIPS) a její řešení. Vnitr̆ Lék 2007; 53(2): 157–163.

9. Fejfar T, Jirkovský V, Šafka V et al. Transjugulární intrahepatální portosystémová spojka – 15 let v Hradci Králové: retrospektivní analýza 694 nemocných. Čes a Slov Gastroent Hepatol 2007; 61(4): 209–216.

10. Huonker M, Schumacher YO, Ochs A et al. Cardiac function and haemodynamics in alcoholic cirrhosis and effects of the transjugular intrahepatic portosystemic stent shunt. Gut 1999; 44(5): 743–748.

11. Colombato LA, Spahr L, Martinet JP et al. Haemodynamic adaptation two months after transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients. Gut 1996; 39(4): 600–604.

12. Stefánková J, Fejfar T, Safka V et al. Hepatic encephalopathy after TIPS – retrospective study. Vnitř Lék 2002; 48(5): 390–395.

13. Walser EM, Nguyen M. Hepatic perfusion and hemodynamic effects of transjugular intrahepatic portosystemic shunts. Semin Intervent Radiol 2005; 22(4): 271–277. doi: 10.1055/s-2005-925553.

14. Riggio O, Angeloni S, Salvatori FM et al. Incidence, natural history, and risk factors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stent grafts. Am J Gastroenterol 2008; 103(11): 2738–2746. doi: 10.1111/j.1572-0241.2008.02102.x.

15. Ginès P, Schrier RW. Renal failure in cirrhosis. N Engl J Med 2009; 361(13): 1279–1290. doi: 10.1056/NEJMra0809139.

16. Azoulay D, Castaing D, Dennison A et al. Transjugular intrahepatic portosystemic shunt worsens the hyperdynamic circulatory state of the cirrhotic patient: preliminary report of a prospective study. Hepatology 1994; 19(1): 129–132.

17. Malinchoc M, Kamath PS, Gordon FD et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000; 31(4): 864–871.

18. Fejfar T, Safka V, Hůlek P et al. MELD skóre v predikci časné mortality u nemocných s refrakterním ascitem léčených pomocí TIPS. Vnitr̆ Lék 2006; 52(9): 771–776.

19. De Franchis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53(4): 762–768. doi: 10.1016/j.jhep.2010.06.004.

20. García-Pagán JC, Caca K, Bureau C et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010; 362(25): 2370–2379. doi: 10.1056/NEJMoa0910102.

21. Boyer TD, Haskal ZJ. The Role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Management of Portal Hypertension: update 2009. Hepatology 2010; 51(1): 306. doi: 10.1002/hep.23383.

22. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53(3): 397–417. doi: 10.1016/j.jhep.2010.05.004.

23. Krajina A, Hulek P, Ferko A et al. Extrahepatic portal venous laceration in TIPS treated with stent graft placement. Hepatogastroenterology 1997; 44(15): 667–670.

24. Safka V, Hůlek P, Krajina A et al. Budd-Chiari syndrome and TIPS – twelve years’ experience. Čas Lék C̆es 2005; 144 (Suppl 3): 38–42.