Cranial stent position is independently associated with the development of TIPS dysfunction.

Autor: Meyer C; Department of Radiology, University Hospital Bonn, Bonn, Germany., Paar Pérez AM; Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany., Chang J; Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany., Sprinkart AM; Department of Radiology, University Hospital Bonn, Bonn, Germany., Böhling N; Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany., Luu AM; Department of General and Visceral Surgery, St. Josef Hospital, University of Bochum, Bochum, Germany., Kütting D; Department of Radiology, University Hospital Bonn, Bonn, Germany., Jansen C; Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany., Luetkens J; Department of Radiology, University Hospital Bonn, Bonn, Germany., Bischoff LM; Department of Radiology, University Hospital Bonn, Bonn, Germany., Attenberger U; Department of Radiology, University Hospital Bonn, Bonn, Germany., Strassburg CP; Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany., Trebicka J; Department of Internal Medicine 1, University of Frankfurt, Frankfurt, Germany.; European Foundation for the Study of Chronic Liver Failure - EF CLIF, Barcelona, Spain., Wolter K; Department of Radiology, University Hospital Bonn, Bonn, Germany., Praktiknjo M; Department of Internal Medicine I, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. michael.praktiknjo@ukbonn.de.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2022 Mar 03; Vol. 12 (1), pp. 3559. Date of Electronic Publication: 2022 Mar 03.
DOI: 10.1038/s41598-022-07595-5
Abstrakt: Complications of portal hypertension can be treated with transjugular intrahepatic portosystemic shunt (TIPS) in selected patients. TIPS dysfunction is a relevant clinical problem. This study investigated the prognostic value of two-dimensional (2D) TIPS geometry for the development of TIPS dysfunction. Three hundred and seven patients undergoing TIPS procedure between 2014 and 2019 were analyzed in this monocentric retrospective study. 2D angiograms from the patients with and without TIPS dysfunction were reviewed to determine geometric characteristics including insertion and curve angles and the location of the stent. Primary outcome was the development of TIPS dysfunction. A total of 70 patients developed TIPS dysfunction and were compared to the dysfunction-free (n = 237) patients. The position of the cranial stent end in the hepatic vein and the persistence of spontaneous portosystemic shunts were significantly associated with the development of TIPS dysfunction. Among significant parameters in univariable regression analysis (portal vein-pressure after TIPS, Child-Pugh Score before TIPS, MELD before TIPS and white blood cell count before TIPS), multivariable models showed cranial stent position (p = 0.027, HR 2.300, 95% CI 1.101-4.806) and SPSS embolization (p = 0.006, HR 0.319, 95% CI 0.140-0.725) as the only predictors of TIPS dysfunction. This monocentric study demonstrates that the position of the cranial stent end is independently associated with the development of TIPS dysfunction. The distance of the cranial stent end to the IVC at the time of TIPS placement should be less than 1 cm in 2D angiography.
(© 2022. The Author(s).)
Databáze: MEDLINE
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