Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy.

Publisher: Baishideng Publishing Group Country of Publication: United States NLM ID: 100883448 Publication Model: Print Cited Medium: Internet ISSN: 2219-2840 (Electronic) Linking ISSN: 10079327 NLM ISO Abbreviation: World J Gastroenterol Subsets: MEDLINE

Publication: 2014- : Pleasanton, CA : Baishideng Publishing Group
Original Publication: Beijing : WJG Press, c1998-

Hepatic Encephalopathy/*epidemiology ; Hypertension, Portal/*surgery ; Liver Cirrhosis/*complications ; Portal Vein/*surgery ; Portasystemic Shunt, Transjugular Intrahepatic/*methods; Adult ; Ascites/diagnosis ; Ascites/epidemiology ; Ascites/etiology ; Esophageal and Gastric Varices/diagnosis ; Esophageal and Gastric Varices/epidemiology ; Esophageal and Gastric Varices/etiology ; Female ; Hepatic Encephalopathy/diagnosis ; Hepatic Encephalopathy/etiology ; Humans ; Hypertension, Portal/etiology ; Incidence ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Treatment Outcome ; Young Adult

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is currently used for the treatment of complications of portal hypertension. The incidence of hepatic encephalopathy (HE) remains a problem in TIPS placement. It has been reported that the right branch mainly receives superior mesenteric venous blood while the left branch mainly receives blood from the splenic vein. We hypothesized that targeted puncture of the left portal vein would divert the non-nutritive blood from the splenic vein into the TIPS shunt; therefore, targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE.
Aim: To evaluate the influence of targeted puncture of left branch of portal vein in TIPS on HE.
Methods: A retrospective analysis of 1244 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2000 to January 2013 was performed. Patients were divided into group A (targeting left branch of portal vein, n = 937) and group B (targeting right branch of portal vein, n = 307). TIPS-related HE and clinical outcomes were analyzed.
Results: The symptoms of ascites and variceal bleeding disappeared within a short time. By the endpoint of follow-up, recurrent bleeding and ascites did not differ significantly between groups A and B ( P = 0.278, P = 0.561, respectively). Incidence of HE differed significantly between groups A and B at 1 mo (14.94% vs 36.80%, χ ² = 4.839, P = 0.028), 3 mo (12.48% vs 34.20%, χ ² = 5.054, P = 0.025), 6 mo (10.03% vs 32.24%, χ ² = 6.560, P = 0.010), 9 mo (9.17% vs 31.27%, χ ² = 5.357, P = 0.021), and 12 mo (8.21% vs 28.01, χ ² = 3.848, P = 0.051). There were no significant differences between groups A and B at 3 years (6.61% vs 7.16%, χ ² = 1.204, P = 0.272) and 5 years (5.01% vs 6.18%, χ ² = 0.072, P = 0.562). The total survival rate did not differ between groups A and B ( χ ² = 0.226, P = 0.634, log-rank test).
Conclusion: Targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE but has no direct influence on prognosis of portal-hypertension-related complications.
Competing Interests: Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study.

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Keywords: Hepatic encephalopathy; Portal hypertension; Portal vein branch; Transjugular intrahepatic portosystemic shunt

Date Created: 20190314 Date Completed: 20190416 Latest Revision: 20200225

20221213

PMC6406189

10.3748/wjg.v25.i9.1088

30862997