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Hsu MC, Weber CN, Stavropoulos SW, et al. Passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes. World J Hepatol. 2017;9(12):603-612doi: 10.4254/wjh.v9.i12.603.
Hsu, M. C., Weber, C. N., Stavropoulos, S. W., Clark, T. W., Trerotola, S. O., Shlansky-Goldberg, R. D., Soulen, M. C., & Nadolski, G. J. (2017). Passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes. World journal of hepatology, 9(12), 603-612. https://doi.org/10.4254/wjh.v9.i12.603
Hsu, Michael C, et al. "Passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes." World journal of hepatology vol. 9,12 (2017): 603-612. doi: https://doi.org/10.4254/wjh.v9.i12.603
Hsu MC, Weber CN, Stavropoulos SW, Clark TW, Trerotola SO, Shlansky-Goldberg RD, Soulen MC, Nadolski GJ. Passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes. World J Hepatol. 2017 Apr 28;9(12):603-612. doi: 10.4254/wjh.v9.i12.603. PMID: 28515846; PMCID: PMC5411955.
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World J Hepatol. 2017 Apr 28;9(12):603-612. doi: 10.4254/wjh.v9.i12.603.

Passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes.

World journal of hepatology

Michael C Hsu, Charles N Weber, S William Stavropoulos, Timothy W Clark, Scott O Trerotola, Richard D Shlansky-Goldberg, Michael C Soulen, Gregory J Nadolski

Affiliations

  1. Michael C Hsu, Department of Radiology, Division of Interventional Radiology, Mount Sinai Hospital, New York, NY 10128, United States.

PMID: 28515846 PMCID: PMC5411955 DOI: 10.4254/wjh.v9.i12.603

Abstract

AIM: To assess for passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts (TIPS) and compare outcomes with maximally dilated TIPS.

METHODS: Polytetrafluoroethylene covered TIPS (Viatorr) from July 2002 to December 2013 were retrospectively reviewed at two hospitals in a single institution. Two hundred and thirty patients had TIPS maximally dilated to 10 mm (mTIPS), while 43 patients who were at increased risk for hepatic encephalopathy (HE), based on clinical evaluation or low pre-TIPS portosystemic gradient (PSG), had 10 mm TIPS sub-maximally dilated to 8 mm (smTIPS). Group characteristics (age, gender, Model for End-Stage Liver Disease score, post-TIPS PSG and clinical outcomes were compared between groups, including clinical success (ascites or varices), primary patency, primary assisted patency, and severe post-TIPS HE. A subset of fourteen patients with smTIPS underwent follow-up computed tomography imaging after TIPS creation, and were grouped based on time of imaging (< 6 mo and > 6 mo). Change in diameter and cross-sectional area were measured with 3D imaging software to evaluate for passive expansion.

RESULTS: Patient characteristics were similar between the smTIPS and mTIPS groups, except for pre-TIPS portosystemic gradient, which was lower in the smTIPS group (19.4 mmHg ± 6.8

CONCLUSION: Passive expansion of smTIPS does occur but clinical outcomes of smTIPS and mTIPS were similar. Sub-maximal dilation can prevent complications related to over-shunting in select patients.

Keywords: Ascites; Hepatic encephalopathy; Passive expansion; Portal hypertension; Sub-maximal dilation; Transjugular intrahepatic portosystemic shunts; Underdilated; Variceal hemorrhage

Conflict of interest statement

Conflict-of-interest statement: None of the authors has any conflict of interest to report.

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