Risk factors for stent graft thrombosis after transjugular intrahepatic portosystemic shunt creation

Younes Jahangiri, Timothy Kerrigan, Lei Li, Dominik Prosser, Anantnoor Brar, Johnathan Righetti, Ryan C. Schenning, John Kaufman, Khashayar Farsad

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: To identify risk factors of stent graft thrombosis after transjugular intrahepatic portosystemic shunt (TIPS) creation. Methods: Patients who underwent TIPS creation between June 2003 and January 2016 and with follow-up assessing stent graft patency were included (n=174). Baseline comorbidities, liver function, procedural details and follow-up liver function tests were analyzed in association with hazards of thrombosis on follow-up. Competing risk cox regression models were used considering liver transplant after TIPS creation as the competing risk variable. Results: One-, 2- and 5-year primary patency rates were 94.1%, 91.7% and 78.2%, respectively. Patient age [sub-hazard ratio (sHR): 1.13; P=0.001], body mass index (BMI) <30 (sHR: 33.08; P=0.008) and a higher post-TIPS portosystemic pressure gradient (sHR: 1.14; P=0.023) were significantly associated with TIPS thrombosis in multivariate analysis. A higher rate of TIPS thrombosis was observed in those for whom the procedure was clinically unsuccessful (P=0.014). A significant increase in incidence of thrombosis was noted with increasing tertiles of post-TIPS portosystemic gradients (P value for trend=0.017). Conclusions: Older age, lower BMI and higher post-TIPS portosystemic gradients were associated with higher hazards of shunt thrombosis after TIPS creation using stent grafts. Higher rates of shunt thrombosis were seen in patients for whom TIPS creation was clinically unsuccessful. The association between TIPS thrombosis and higher post-TIPS portosystemic gradients may indicate impaired flow through the shunt, a finding which may be technical or anatomic in nature and should be assessed before procedure completion.

Original languageEnglish (US)
Pages (from-to)S150-S158
JournalCardiovascular Diagnosis and Therapy
Volume7
DOIs
StatePublished - Dec 1 2017

Fingerprint

Transjugular Intrahepatic Portasystemic Shunt
Stents
Thrombosis
Transplants
Body Mass Index
Liver
Liver Function Tests
Proportional Hazards Models
Comorbidity

Keywords

  • Portal hypertension
  • Stent graft
  • Thrombosis
  • Transjugular intrahepatic portosystemic shunt (TIPS)
  • Viatorr

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Risk factors for stent graft thrombosis after transjugular intrahepatic portosystemic shunt creation. / Jahangiri, Younes; Kerrigan, Timothy; Li, Lei; Prosser, Dominik; Brar, Anantnoor; Righetti, Johnathan; Schenning, Ryan C.; Kaufman, John; Farsad, Khashayar.

In: Cardiovascular Diagnosis and Therapy, Vol. 7, 01.12.2017, p. S150-S158.

Research output: Contribution to journalArticle

Jahangiri, Younes ; Kerrigan, Timothy ; Li, Lei ; Prosser, Dominik ; Brar, Anantnoor ; Righetti, Johnathan ; Schenning, Ryan C. ; Kaufman, John ; Farsad, Khashayar. / Risk factors for stent graft thrombosis after transjugular intrahepatic portosystemic shunt creation. In: Cardiovascular Diagnosis and Therapy. 2017 ; Vol. 7. pp. S150-S158.
@article{d6003e8fcd0c4a3881f8c2bb9d9e3cd4,
title = "Risk factors for stent graft thrombosis after transjugular intrahepatic portosystemic shunt creation",
abstract = "Background: To identify risk factors of stent graft thrombosis after transjugular intrahepatic portosystemic shunt (TIPS) creation. Methods: Patients who underwent TIPS creation between June 2003 and January 2016 and with follow-up assessing stent graft patency were included (n=174). Baseline comorbidities, liver function, procedural details and follow-up liver function tests were analyzed in association with hazards of thrombosis on follow-up. Competing risk cox regression models were used considering liver transplant after TIPS creation as the competing risk variable. Results: One-, 2- and 5-year primary patency rates were 94.1{\%}, 91.7{\%} and 78.2{\%}, respectively. Patient age [sub-hazard ratio (sHR): 1.13; P=0.001], body mass index (BMI) <30 (sHR: 33.08; P=0.008) and a higher post-TIPS portosystemic pressure gradient (sHR: 1.14; P=0.023) were significantly associated with TIPS thrombosis in multivariate analysis. A higher rate of TIPS thrombosis was observed in those for whom the procedure was clinically unsuccessful (P=0.014). A significant increase in incidence of thrombosis was noted with increasing tertiles of post-TIPS portosystemic gradients (P value for trend=0.017). Conclusions: Older age, lower BMI and higher post-TIPS portosystemic gradients were associated with higher hazards of shunt thrombosis after TIPS creation using stent grafts. Higher rates of shunt thrombosis were seen in patients for whom TIPS creation was clinically unsuccessful. The association between TIPS thrombosis and higher post-TIPS portosystemic gradients may indicate impaired flow through the shunt, a finding which may be technical or anatomic in nature and should be assessed before procedure completion.",
keywords = "Portal hypertension, Stent graft, Thrombosis, Transjugular intrahepatic portosystemic shunt (TIPS), Viatorr",
author = "Younes Jahangiri and Timothy Kerrigan and Lei Li and Dominik Prosser and Anantnoor Brar and Johnathan Righetti and Schenning, {Ryan C.} and John Kaufman and Khashayar Farsad",
year = "2017",
month = "12",
day = "1",
doi = "10.21037/cdt.2017.10.03",
language = "English (US)",
volume = "7",
pages = "S150--S158",
journal = "Cardiovascular Diagnosis and Therapy",
issn = "2223-3652",
publisher = "AME Publishing Company",

}

TY - JOUR

T1 - Risk factors for stent graft thrombosis after transjugular intrahepatic portosystemic shunt creation

AU - Jahangiri, Younes

AU - Kerrigan, Timothy

AU - Li, Lei

AU - Prosser, Dominik

AU - Brar, Anantnoor

AU - Righetti, Johnathan

AU - Schenning, Ryan C.

AU - Kaufman, John

AU - Farsad, Khashayar

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background: To identify risk factors of stent graft thrombosis after transjugular intrahepatic portosystemic shunt (TIPS) creation. Methods: Patients who underwent TIPS creation between June 2003 and January 2016 and with follow-up assessing stent graft patency were included (n=174). Baseline comorbidities, liver function, procedural details and follow-up liver function tests were analyzed in association with hazards of thrombosis on follow-up. Competing risk cox regression models were used considering liver transplant after TIPS creation as the competing risk variable. Results: One-, 2- and 5-year primary patency rates were 94.1%, 91.7% and 78.2%, respectively. Patient age [sub-hazard ratio (sHR): 1.13; P=0.001], body mass index (BMI) <30 (sHR: 33.08; P=0.008) and a higher post-TIPS portosystemic pressure gradient (sHR: 1.14; P=0.023) were significantly associated with TIPS thrombosis in multivariate analysis. A higher rate of TIPS thrombosis was observed in those for whom the procedure was clinically unsuccessful (P=0.014). A significant increase in incidence of thrombosis was noted with increasing tertiles of post-TIPS portosystemic gradients (P value for trend=0.017). Conclusions: Older age, lower BMI and higher post-TIPS portosystemic gradients were associated with higher hazards of shunt thrombosis after TIPS creation using stent grafts. Higher rates of shunt thrombosis were seen in patients for whom TIPS creation was clinically unsuccessful. The association between TIPS thrombosis and higher post-TIPS portosystemic gradients may indicate impaired flow through the shunt, a finding which may be technical or anatomic in nature and should be assessed before procedure completion.

AB - Background: To identify risk factors of stent graft thrombosis after transjugular intrahepatic portosystemic shunt (TIPS) creation. Methods: Patients who underwent TIPS creation between June 2003 and January 2016 and with follow-up assessing stent graft patency were included (n=174). Baseline comorbidities, liver function, procedural details and follow-up liver function tests were analyzed in association with hazards of thrombosis on follow-up. Competing risk cox regression models were used considering liver transplant after TIPS creation as the competing risk variable. Results: One-, 2- and 5-year primary patency rates were 94.1%, 91.7% and 78.2%, respectively. Patient age [sub-hazard ratio (sHR): 1.13; P=0.001], body mass index (BMI) <30 (sHR: 33.08; P=0.008) and a higher post-TIPS portosystemic pressure gradient (sHR: 1.14; P=0.023) were significantly associated with TIPS thrombosis in multivariate analysis. A higher rate of TIPS thrombosis was observed in those for whom the procedure was clinically unsuccessful (P=0.014). A significant increase in incidence of thrombosis was noted with increasing tertiles of post-TIPS portosystemic gradients (P value for trend=0.017). Conclusions: Older age, lower BMI and higher post-TIPS portosystemic gradients were associated with higher hazards of shunt thrombosis after TIPS creation using stent grafts. Higher rates of shunt thrombosis were seen in patients for whom TIPS creation was clinically unsuccessful. The association between TIPS thrombosis and higher post-TIPS portosystemic gradients may indicate impaired flow through the shunt, a finding which may be technical or anatomic in nature and should be assessed before procedure completion.

KW - Portal hypertension

KW - Stent graft

KW - Thrombosis

KW - Transjugular intrahepatic portosystemic shunt (TIPS)

KW - Viatorr

UR - http://www.scopus.com/inward/record.url?scp=85038626099&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85038626099&partnerID=8YFLogxK

U2 - 10.21037/cdt.2017.10.03

DO - 10.21037/cdt.2017.10.03

M3 - Article

AN - SCOPUS:85038626099

VL - 7

SP - S150-S158

JO - Cardiovascular Diagnosis and Therapy

JF - Cardiovascular Diagnosis and Therapy

SN - 2223-3652

ER -