World J Hepatol. 2012 February 27; 4(2): 35-42.
Published online 2012 February 27. doi: 10.4254/wjh.v4.i2.35.
Transjugular intrahepatic porto-systemic shunt in the elderly: Palliation for complications of portal hypertension
Mubin I Syed, Hetal Karsan, Hector Ferral, Azim Shaikh, Uzma Waheed, Talal Akhter, Alan Gabbard, Kamal Morar and Robert Tyrrell.
Mubin I Syed, Azim Shaikh, Uzma Waheed, Kamal Morar, Robert Tyrrell, Dayton Interventional Radiology, Dayton, OH 45409, United States
Mubin I Syed, Kamal Morar, Robert Tyrrell, Department of Radiological Sciences, Wright State University School of Medicine, Dayton, OH 45409, United States
Hetal Karsan, Department of Hepatology, Emory University, Atlanta, GA 30322, United States
Hector Ferral, Department of Interventional Radiology, Rush University Medical Center, Chicago, IL 60612, United States
Talal Akhter, Department of the College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, United States
Alan Gabbard, Department of Gastroenterology, Springfield Regional Medical Center, Springfield, OH 45505, United States
Author contributions: All authors contributed equally to this paper.
Correspondence to: Mubin I Syed, MD, FSIR, FACR, Dayton Interventional Radiology, 3075 Governors Place Blvd., Ste. 120, Dayton, OH 45409, United States. mubinsyed@aol.com
Telephone: +1-937-4242580 Fax: +1-937-4242581
Received August 17, 2011; Revised January 8, 2012; Accepted February 24, 2012;
Abstract
AIM: To present a dedicated series of transjugular intrahepatic porto-systemic shunts (TIPS) in the elderly since data is sparse on this population group.
METHODS: A retrospective review was performed of patients at least 65 years of age who underwent TIPS at our institutions between 1997 and 2010. Twenty-five patients were referred for TIPS. We deemed that 2 patients were not considered appropriate candidates due to their markedly advanced liver disease. Of the 23 patients suitable for TIPS, the indications for TIPS placement was portal hypertension complicated by refractory ascites alone (n = 9), hepatic hydrothorax alone (n = 2), refractory ascites and hydrothorax (n = 1), gastrointestinal bleeding alone (n = 8), gastrointestinal bleeding and ascites (n = 3).
RESULTS: Of these 23 attempted TIPS procedure patients, 21 patients had technically successful TIPS procedures. A total of 29 out of 32 TIPS procedures including revisions were successful in 21 patients with a mean age of 72.1 years (range 65-82 years). Three of the procedures were unsuccessful attempts at TIPS and 8 procedures were successful revisions of our existing TIPS. Sixteen of 21 patients who underwent successful TIPS (excluding 5 patients lost to follow-up) were followed for a mean of 14.7 mo. Ascites and/or hydrothorax was controlled following technically successful procedures in 12 of 13 patients. Bleeding was controlled following technically successful procedures in 10 out of 11 patients.
CONCLUSION: We have demonstrated that TIPS is an effective procedure to control refractory complications of portal hypertension in elderly patients.
Keywords: Transjugular intrahepatic porto-systemic shunt, Portal hypertension, Elderly, Ascites, Cirrhosis