Procedural and shunt‐related complications and mortality of the transjugular intrahepatic portosystemic shunt (TIPSS). Issue 10 (27th September 2016)

• Record Type: Journal Article
• Authors: Bettinger, D.; Schultheiss, M.; Boettler, T.; Muljono, M.; Thimme, R.; Rössle, M.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 44:Issue 10(2016)
• Page Start: 1051
• Page End: 1061
• Publication Date: 2016-09-27
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.13809
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background: The implantation of a transjugular intrahepatic portosystemic shunt (TIPSS) is a complex angiographic procedure performed in patients with end‐stage liver disease. Numerous case reports and narrative reviews have been published so far; however, studies systematically investigating procedural and shunt‐related complications are lacking. Aim: To systematically investigate complications and mortality occurring during the index hospital stay and the early (4‐week) period after TIPSS implantation. Methods: The study includes 389 patients who received a TIPSS implantation between 2004 and 2014. Data were obtained from the clinical records and technical reports of the TIPSS implantation. Results: During the index hospital stay, procedure‐related complications occurred in 42 patients (10.8%) with intraperitoneal bleeding in 8 patients (2.1%) and infections in 14 patients (3.6%). Shunt‐ and disease‐related complications consisted of hepatic encephalopathy (1‐year incidence 29%), non‐procedural infections (8.7%) and acute hepatic decompensation (4.1%). Nine patients (2.3%) died during the index hospital stay from procedure‐related (two patients, 0.5%), shunt‐related (four patients, 1%) or disease‐related causes (three patients, 0.8%). 23 patients (5.9%) died during 4 weeks after TIPSS implantation. The 1‐year probability of survival was 67.7% and was negatively associated with severe hepatic encephalopathy and acute hepatic decompensation. Conclusions: Except hepatic encephalopathy, severe procedure‐ and shunt‐related complications are rare and early mortality is low.