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Shunting branch of portal vein and stent position predict survival after transjugular intrahepatic portosystemic shunt.
World J Gastroenterol. 2014 Jan 21; 20(3):774-85.WJ

Abstract

AIM

To evaluate the effect of the shunting branch of the portal vein (PV) (left or right) and the initial stent position (optimal or suboptimal) of a transjugular intrahepatic portosystemic shunt (TIPS).

METHODS

We retrospectively reviewed 307 consecutive cirrhotic patients who underwent TIPS placement for variceal bleeding from March 2001 to July 2010 at our center. The left PV was used in 221 patients and the right PV in the remaining 86 patients. And, 224 and 83 patients have optimal stent position and sub-optimal stent positions, respectively. The patients were followed until October 2011 or their death. Hepatic encephalopathy, shunt dysfunction, and survival were evaluated as outcomes. The difference between the groups was compared by Kaplan-Meier analysis. A Cox regression model was employed to evaluate the predictors.

RESULTS

Among the patients who underwent TIPS to the left PV, the risk of hepatic encephalopathy (P = 0.002) and mortality were lower (P < 0.001) compared to those to the right PV. Patients who underwent TIPS with optimal initial stent position had a higher primary patency (P < 0.001) and better survival (P = 0.006) than those with suboptimal initial stent position. The shunting branch of the portal vein and the initial stent position were independent predictors of hepatic encephalopathy and shunt dysfunction after TIPS, respectively. And, both were independent predictors of survival.

CONCLUSION

TIPS placed to the left portal vein with optimal stent position may reduce the risk of hepatic encephalopathy and improve the primary patency rates, thereby prolonging survival.

Authors+Show Affiliations

Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24574750

Citation

Bai, Ming, et al. "Shunting Branch of Portal Vein and Stent Position Predict Survival After Transjugular Intrahepatic Portosystemic Shunt." World Journal of Gastroenterology, vol. 20, no. 3, 2014, pp. 774-85.
Bai M, He CY, Qi XS, et al. Shunting branch of portal vein and stent position predict survival after transjugular intrahepatic portosystemic shunt. World J Gastroenterol. 2014;20(3):774-85.
Bai, M., He, C. Y., Qi, X. S., Yin, Z. X., Wang, J. H., Guo, W. G., Niu, J., Xia, J. L., Zhang, Z. L., Larson, A. C., Wu, K. C., Fan, D. M., & Han, G. H. (2014). Shunting branch of portal vein and stent position predict survival after transjugular intrahepatic portosystemic shunt. World Journal of Gastroenterology, 20(3), 774-85. https://doi.org/10.3748/wjg.v20.i3.774
Bai M, et al. Shunting Branch of Portal Vein and Stent Position Predict Survival After Transjugular Intrahepatic Portosystemic Shunt. World J Gastroenterol. 2014 Jan 21;20(3):774-85. PubMed PMID: 24574750.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Shunting branch of portal vein and stent position predict survival after transjugular intrahepatic portosystemic shunt. AU - Bai,Ming, AU - He,Chuang-Ye, AU - Qi,Xing-Shun, AU - Yin,Zhan-Xin, AU - Wang,Jian-Hong, AU - Guo,Wen-Gang, AU - Niu,Jing, AU - Xia,Jie-Lai, AU - Zhang,Zhuo-Li, AU - Larson,Andrew C, AU - Wu,Kai-Chun, AU - Fan,Dai-Ming, AU - Han,Guo-Hong, PY - 2013/08/28/received PY - 2013/10/22/revised PY - 2013/11/01/accepted PY - 2014/2/28/entrez PY - 2014/2/28/pubmed PY - 2014/11/18/medline KW - Cirrhosis KW - Portal vein KW - Stent position KW - Transjugular intrahepatic portosystemic shunt KW - Variceal bleeding SP - 774 EP - 85 JF - World journal of gastroenterology JO - World J Gastroenterol VL - 20 IS - 3 N2 - AIM: To evaluate the effect of the shunting branch of the portal vein (PV) (left or right) and the initial stent position (optimal or suboptimal) of a transjugular intrahepatic portosystemic shunt (TIPS). METHODS: We retrospectively reviewed 307 consecutive cirrhotic patients who underwent TIPS placement for variceal bleeding from March 2001 to July 2010 at our center. The left PV was used in 221 patients and the right PV in the remaining 86 patients. And, 224 and 83 patients have optimal stent position and sub-optimal stent positions, respectively. The patients were followed until October 2011 or their death. Hepatic encephalopathy, shunt dysfunction, and survival were evaluated as outcomes. The difference between the groups was compared by Kaplan-Meier analysis. A Cox regression model was employed to evaluate the predictors. RESULTS: Among the patients who underwent TIPS to the left PV, the risk of hepatic encephalopathy (P = 0.002) and mortality were lower (P < 0.001) compared to those to the right PV. Patients who underwent TIPS with optimal initial stent position had a higher primary patency (P < 0.001) and better survival (P = 0.006) than those with suboptimal initial stent position. The shunting branch of the portal vein and the initial stent position were independent predictors of hepatic encephalopathy and shunt dysfunction after TIPS, respectively. And, both were independent predictors of survival. CONCLUSION: TIPS placed to the left portal vein with optimal stent position may reduce the risk of hepatic encephalopathy and improve the primary patency rates, thereby prolonging survival. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/24574750/Shunting_branch_of_portal_vein_and_stent_position_predict_survival_after_transjugular_intrahepatic_portosystemic_shunt_ L2 - https://www.wjgnet.com/1007-9327/full/v20/i3/774.htm DB - PRIME DP - Unbound Medicine ER -