High Incidence of Hepatic Encephalopathy After Viatorr Controlled Expansion Transjugular Intrahepatic Portosystemic Shun
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ORIGINAL ARTICLE
High Incidence of Hepatic Encephalopathy After Viatorr Controlled Expansion Transjugular Intrahepatic Portosystemic Shunt Creation Marie‑Louise Kloster1 · Albert Ren2 · Ketan Y. Shah1 · Murad M. Alqadi1 · James T. Bui1 · Andrew J. Lipnik1 · Matthew M. Niemeyer1 · Charles E. Ray1 · Ron C. Gaba2 Received: 12 September 2020 / Accepted: 10 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The Viatorr Controlled Expansion (VCX) stent-graft was designed to mitigate hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation. Aims To determine the incidence and degree of HE after VCX TIPS. Methods Thirty-three patients (M:F 17:16, mean age 58 years, mean MELD score 12) who underwent VCX TIPS between 2018 and 2019 were retrospectively studied. 11/33 (33%) patients had medically controlled pre-TIPS HE. TIPS indications included variceal hemorrhage (n = 12, 30%) and ascites (n = 21, 70%). Measured outcomes were post-TIPS HE (overall, recurrent, de novo) graded using the West Haven system, time-to-HE occurrence, HE-related hospitalization rate, and TIPS reduction rate. Results VCX TIPS were 8 mm in 28/33 (85%) and 10 mm in 5/33 (15%). Mean final portosystemic pressure gradient was 6 mmHg. Cumulative HE incidence post-TIPS was 61% (20/33). 1-, 3-, 6-, and 12-month HE rates were 24%, 30%, 53%, and 61% over 247-day median follow-up. Median time-to-HE was 180 days. HE grades spanned grade 1 (n = 6), grade 2 (n = 8), and grade 3 (n = 6); 9 and 11 cases were recurrent and de novo HE, respectively. Medication non-compliance/infection was implicated in HE in 9/20 (45%) cases. Medical therapy addressed HE in 18/20 (90%) cases; however, HE still resulted in 39 hospitalizations among 13 patients, and median time to first hospitalization was 75 days. Shunt reduction was necessary in 2 (10%) cases of medically refractory HE. Conclusions The incidence of HE after VCX TIPS is high. Though HE symptoms may be medically controlled, hospitalization rates are high, and shunt reduction may be necessary. Keywords Transjugular intrahepatic portosystemic shunt (TIPS) · Stent-graft · Hepatic encephalopathy (HE) · Portal hypertension
Introduction Hepatic encephalopathy (HE) is a condition defined by progressive neurological changes that range from mild confusion to coma and may be precipitated in 10–50% of patients after transjugular intrahepatic portosystemic shunt (TIPS) creation [1]. In order to avoid portosystemic pressure gradient (PSG) over-reduction and minimize risks for HE in * Ron C. Gaba [email protected] 1
College of Medicine, University of Illinois at Chicago, Chicago, USA
Department of Radiology, University of Illinois at Chicago, 1740 West Taylor Street, MC 931, Chicago, IL 60612, USA
2
TIPS patients, TIPS stent-grafts are often under-dilated to the minimum diameter needed to achieve an optimal PSG, so as to allow sufficient portal vein shunting to mitigate portal hypertension complications, but not so excessive as to
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