Transjugular intrahepatic portosystemic shunt patency and the importance of stenosis location in the development of recurrent symptoms

Richard R. Saxon, Penny L. Ross, Janet Mendel-Hartvig, Robert Barton, Kent Benner, Ken Flora, Bryan Petersen, Paul C. Lakin, Frederick Keller

Research output: Contribution to journalArticle

99 Citations (Scopus)

Abstract

PURPOSE: To analyze in detail the location and types of stenosis and occlusion that occur after transjugular intrahepatic portosystemic shunt (TIPS) creation and to determine the relative contribution of these various types of TIPS malfunction to recurrent symptoms of variceal bleeding or ascites. MATERIALS AND METHODS: In 116 of 217 patients who underwent TIPS creation between June 1990 and July 1995, follow-up portal venography was performed at 6-month intervals and for symptoms of recurrent variceal bleeding or ascites. RESULTS: Cumulative primary venographic patency by means of Kaplan-Meler survival analysis was 55% at 6 months and 5% at 2 years. Secondary patency was 92% at 2 years. Stenosis or occlusion occurred in 63 of 116 patients (54%). In 20 patients (17%), acute shunt occlusions developed less than 30 days after TIPS creation; in 24 patients (21%), tract abnormalities were detected after 30 days; and in 19 patients (16%), hepatic vein stenoses were detected after 30 days. Abnormalities of the parenchymal tract were more often correlated with recurrent variceal bleeding or ascites than were hepatic vein stenoses (odds ratio, 3.6; P = .02). Ten of 14 patients (71%) with detected biliary fistulas to their TIPS had symptoms, and all patients with biliary fistulas had tract abnormalities. CONCLUSION: Tract stenoses and occlusions were the major cause of symptomatic shunt failure after TIPS creation. Substantial bile duct transections are often associated with tract abnormalities and recurrent symptoms. Although common, hepatic vein stenoses were rarely associated with recurrent symptoms in our patient population.

Original languageEnglish (US)
Pages (from-to)683-693
Number of pages11
JournalRadiology
Volume207
Issue number3
StatePublished - Jun 1998

Fingerprint

Transjugular Intrahepatic Portasystemic Shunt
Pathologic Constriction
Hepatic Veins
Ascites
Biliary Fistula
Hemorrhage
Phlebography
Survival Analysis
Bile Ducts
Odds Ratio

Keywords

  • Liver, interventional procedure, 761.126
  • Portal veins, stenosis or obstruction, 957.442, 957.443
  • Shunts, portosystemic, 957.453
  • Stents and prostheses, 761.126

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

Transjugular intrahepatic portosystemic shunt patency and the importance of stenosis location in the development of recurrent symptoms. / Saxon, Richard R.; Ross, Penny L.; Mendel-Hartvig, Janet; Barton, Robert; Benner, Kent; Flora, Ken; Petersen, Bryan; Lakin, Paul C.; Keller, Frederick.

In: Radiology, Vol. 207, No. 3, 06.1998, p. 683-693.

Research output: Contribution to journalArticle

Saxon, RR, Ross, PL, Mendel-Hartvig, J, Barton, R, Benner, K, Flora, K, Petersen, B, Lakin, PC & Keller, F 1998, 'Transjugular intrahepatic portosystemic shunt patency and the importance of stenosis location in the development of recurrent symptoms', Radiology, vol. 207, no. 3, pp. 683-693.
Saxon, Richard R. ; Ross, Penny L. ; Mendel-Hartvig, Janet ; Barton, Robert ; Benner, Kent ; Flora, Ken ; Petersen, Bryan ; Lakin, Paul C. ; Keller, Frederick. / Transjugular intrahepatic portosystemic shunt patency and the importance of stenosis location in the development of recurrent symptoms. In: Radiology. 1998 ; Vol. 207, No. 3. pp. 683-693.
@article{fbb9f281acce435bb9031260d4ef212e,
title = "Transjugular intrahepatic portosystemic shunt patency and the importance of stenosis location in the development of recurrent symptoms",
abstract = "PURPOSE: To analyze in detail the location and types of stenosis and occlusion that occur after transjugular intrahepatic portosystemic shunt (TIPS) creation and to determine the relative contribution of these various types of TIPS malfunction to recurrent symptoms of variceal bleeding or ascites. MATERIALS AND METHODS: In 116 of 217 patients who underwent TIPS creation between June 1990 and July 1995, follow-up portal venography was performed at 6-month intervals and for symptoms of recurrent variceal bleeding or ascites. RESULTS: Cumulative primary venographic patency by means of Kaplan-Meler survival analysis was 55{\%} at 6 months and 5{\%} at 2 years. Secondary patency was 92{\%} at 2 years. Stenosis or occlusion occurred in 63 of 116 patients (54{\%}). In 20 patients (17{\%}), acute shunt occlusions developed less than 30 days after TIPS creation; in 24 patients (21{\%}), tract abnormalities were detected after 30 days; and in 19 patients (16{\%}), hepatic vein stenoses were detected after 30 days. Abnormalities of the parenchymal tract were more often correlated with recurrent variceal bleeding or ascites than were hepatic vein stenoses (odds ratio, 3.6; P = .02). Ten of 14 patients (71{\%}) with detected biliary fistulas to their TIPS had symptoms, and all patients with biliary fistulas had tract abnormalities. CONCLUSION: Tract stenoses and occlusions were the major cause of symptomatic shunt failure after TIPS creation. Substantial bile duct transections are often associated with tract abnormalities and recurrent symptoms. Although common, hepatic vein stenoses were rarely associated with recurrent symptoms in our patient population.",
keywords = "Liver, interventional procedure, 761.126, Portal veins, stenosis or obstruction, 957.442, 957.443, Shunts, portosystemic, 957.453, Stents and prostheses, 761.126",
author = "Saxon, {Richard R.} and Ross, {Penny L.} and Janet Mendel-Hartvig and Robert Barton and Kent Benner and Ken Flora and Bryan Petersen and Lakin, {Paul C.} and Frederick Keller",
year = "1998",
month = "6",
language = "English (US)",
volume = "207",
pages = "683--693",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
number = "3",

}

TY - JOUR

T1 - Transjugular intrahepatic portosystemic shunt patency and the importance of stenosis location in the development of recurrent symptoms

AU - Saxon, Richard R.

AU - Ross, Penny L.

AU - Mendel-Hartvig, Janet

AU - Barton, Robert

AU - Benner, Kent

AU - Flora, Ken

AU - Petersen, Bryan

AU - Lakin, Paul C.

AU - Keller, Frederick

PY - 1998/6

Y1 - 1998/6

N2 - PURPOSE: To analyze in detail the location and types of stenosis and occlusion that occur after transjugular intrahepatic portosystemic shunt (TIPS) creation and to determine the relative contribution of these various types of TIPS malfunction to recurrent symptoms of variceal bleeding or ascites. MATERIALS AND METHODS: In 116 of 217 patients who underwent TIPS creation between June 1990 and July 1995, follow-up portal venography was performed at 6-month intervals and for symptoms of recurrent variceal bleeding or ascites. RESULTS: Cumulative primary venographic patency by means of Kaplan-Meler survival analysis was 55% at 6 months and 5% at 2 years. Secondary patency was 92% at 2 years. Stenosis or occlusion occurred in 63 of 116 patients (54%). In 20 patients (17%), acute shunt occlusions developed less than 30 days after TIPS creation; in 24 patients (21%), tract abnormalities were detected after 30 days; and in 19 patients (16%), hepatic vein stenoses were detected after 30 days. Abnormalities of the parenchymal tract were more often correlated with recurrent variceal bleeding or ascites than were hepatic vein stenoses (odds ratio, 3.6; P = .02). Ten of 14 patients (71%) with detected biliary fistulas to their TIPS had symptoms, and all patients with biliary fistulas had tract abnormalities. CONCLUSION: Tract stenoses and occlusions were the major cause of symptomatic shunt failure after TIPS creation. Substantial bile duct transections are often associated with tract abnormalities and recurrent symptoms. Although common, hepatic vein stenoses were rarely associated with recurrent symptoms in our patient population.

AB - PURPOSE: To analyze in detail the location and types of stenosis and occlusion that occur after transjugular intrahepatic portosystemic shunt (TIPS) creation and to determine the relative contribution of these various types of TIPS malfunction to recurrent symptoms of variceal bleeding or ascites. MATERIALS AND METHODS: In 116 of 217 patients who underwent TIPS creation between June 1990 and July 1995, follow-up portal venography was performed at 6-month intervals and for symptoms of recurrent variceal bleeding or ascites. RESULTS: Cumulative primary venographic patency by means of Kaplan-Meler survival analysis was 55% at 6 months and 5% at 2 years. Secondary patency was 92% at 2 years. Stenosis or occlusion occurred in 63 of 116 patients (54%). In 20 patients (17%), acute shunt occlusions developed less than 30 days after TIPS creation; in 24 patients (21%), tract abnormalities were detected after 30 days; and in 19 patients (16%), hepatic vein stenoses were detected after 30 days. Abnormalities of the parenchymal tract were more often correlated with recurrent variceal bleeding or ascites than were hepatic vein stenoses (odds ratio, 3.6; P = .02). Ten of 14 patients (71%) with detected biliary fistulas to their TIPS had symptoms, and all patients with biliary fistulas had tract abnormalities. CONCLUSION: Tract stenoses and occlusions were the major cause of symptomatic shunt failure after TIPS creation. Substantial bile duct transections are often associated with tract abnormalities and recurrent symptoms. Although common, hepatic vein stenoses were rarely associated with recurrent symptoms in our patient population.

KW - Liver, interventional procedure, 761.126

KW - Portal veins, stenosis or obstruction, 957.442, 957.443

KW - Shunts, portosystemic, 957.453

KW - Stents and prostheses, 761.126

UR - http://www.scopus.com/inward/record.url?scp=0031839192&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031839192&partnerID=8YFLogxK

M3 - Article

C2 - 9609891

AN - SCOPUS:0031839192

VL - 207

SP - 683

EP - 693

JO - Radiology

JF - Radiology

SN - 0033-8419

IS - 3

ER -