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Post-shunt resource consumption favors small-diameter prosthetic H-graft portacaval shunt over TIPS for patients with poor hepatic reserve.
Ann Surg. 2003 Jun; 237(6):820-5; discussion 825-7.AnnS

Abstract

OBJECTIVE

To define the role of surgical shunting for patients with poor hepatic reserve (Child's class C) in the era of TIPS.

SUMMARY BACKGROUND DATA

Most physicians prefer TIPS to surgical shunting for patients with poor hepatic reserve because of anticipated poor long-term survival.

METHODS

Sixty-two patients of Child's class C with bleeding varices not amenable to endoscopic sclerotherapy or banding were prospectively randomized to undergo TIPS or 8-mm prosthetic H-graft portacaval shunt (HGPCS) from 1993 to 1999. Resource consumption and survival after shunting were determined.

RESULTS

Twenty-nine patients underwent TIPS and 33 underwent HGPCS. After HGPCS, survival at 3 years was favorable but not statistically superior. TIPS was more often associated with shunt stenoses/occlusions, recurrent hemorrhage, shunt revisions, and shunt failure. Long-term follow-up documented that after HGPCS, patients required fewer hospital and ICU days and fewer units of RBCs transfused. After HGPCS, cost of care was less, as was the median cost of care per day of survival.

CONCLUSIONS

For Child's class C patients undergoing HGPCS or TIPS, long-term survival is similar, though favoring HGPCS. Similarly, measures of resource consumption and cost of care following hospital discharge favor HGPCS. HGPCS should be preferentially applied for acceptable patients without access to convenient capable post-shunt care or without definitive plans for imminent transplantation.

Links

Publisher Full Text
ncbi.nlm.nih.gov
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Authors+Show Affiliations

Rosemurgy AS
Department of Surgery, University of South Florida, Tampa General Hospital, 1 Davis Boulevard, Box 1289, Room F-145, Tampa, FL 33601, USA. arosemur@hsc.usf.edu
Zervos EE
No affiliation info available
Bloomston M
No affiliation info available
Durkin AJ
No affiliation info available
Clark WC
No affiliation info available
Goff S
No affiliation info available

MeSH

AdultAgedBlood Vessel Prosthesis ImplantationDecompression, SurgicalErythrocyte TransfusionEsophageal and Gastric VaricesFemaleGastrointestinal HemorrhageHumansLength of StayMaleMiddle AgedPortacaval Shunt, SurgicalPortasystemic Shunt, Transjugular IntrahepaticPostoperative PeriodProspective Studies

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

12796578

Citation

Rosemurgy, Alexander S., et al. "Post-shunt Resource Consumption Favors Small-diameter Prosthetic H-graft Portacaval Shunt Over TIPS for Patients With Poor Hepatic Reserve." Annals of Surgery, vol. 237, no. 6, 2003, pp. 820-5; discussion 825-7.
Rosemurgy AS, Zervos EE, Bloomston M, et al. Post-shunt resource consumption favors small-diameter prosthetic H-graft portacaval shunt over TIPS for patients with poor hepatic reserve. Ann Surg. 2003;237(6):820-5; discussion 825-7.
Rosemurgy, A. S., Zervos, E. E., Bloomston, M., Durkin, A. J., Clark, W. C., & Goff, S. (2003). Post-shunt resource consumption favors small-diameter prosthetic H-graft portacaval shunt over TIPS for patients with poor hepatic reserve. Annals of Surgery, 237(6), 820-5; discussion 825-7.
Rosemurgy AS, et al. Post-shunt Resource Consumption Favors Small-diameter Prosthetic H-graft Portacaval Shunt Over TIPS for Patients With Poor Hepatic Reserve. Ann Surg. 2003;237(6):820-5; discussion 825-7. PubMed PMID: 12796578.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Post-shunt resource consumption favors small-diameter prosthetic H-graft portacaval shunt over TIPS for patients with poor hepatic reserve. AU - Rosemurgy,Alexander S, AU - Zervos,Emmanuel E, AU - Bloomston,Mark, AU - Durkin,Alan J, AU - Clark,Whalen C, AU - Goff,Stephanie, PY - 2003/6/11/pubmed PY - 2003/7/15/medline PY - 2003/6/11/entrez SP - 820-5; discussion 825-7 JF - Annals of surgery JO - Ann Surg VL - 237 IS - 6 N2 - OBJECTIVE: To define the role of surgical shunting for patients with poor hepatic reserve (Child's class C) in the era of TIPS. SUMMARY BACKGROUND DATA: Most physicians prefer TIPS to surgical shunting for patients with poor hepatic reserve because of anticipated poor long-term survival. METHODS: Sixty-two patients of Child's class C with bleeding varices not amenable to endoscopic sclerotherapy or banding were prospectively randomized to undergo TIPS or 8-mm prosthetic H-graft portacaval shunt (HGPCS) from 1993 to 1999. Resource consumption and survival after shunting were determined. RESULTS: Twenty-nine patients underwent TIPS and 33 underwent HGPCS. After HGPCS, survival at 3 years was favorable but not statistically superior. TIPS was more often associated with shunt stenoses/occlusions, recurrent hemorrhage, shunt revisions, and shunt failure. Long-term follow-up documented that after HGPCS, patients required fewer hospital and ICU days and fewer units of RBCs transfused. After HGPCS, cost of care was less, as was the median cost of care per day of survival. CONCLUSIONS: For Child's class C patients undergoing HGPCS or TIPS, long-term survival is similar, though favoring HGPCS. Similarly, measures of resource consumption and cost of care following hospital discharge favor HGPCS. HGPCS should be preferentially applied for acceptable patients without access to convenient capable post-shunt care or without definitive plans for imminent transplantation. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/12796578/Post_shunt_resource_consumption_favors_small_diameter_prosthetic_H_graft_portacaval_shunt_over_TIPS_for_patients_with_poor_hepatic_reserve_ L2 - https://journals.lww.com/12796578.pmid DB - PRIME DP - Unbound Medicine ER -