Published online Jan 21, 2014. doi: 10.3748/wjg.v20.i3.774
Revised: October 22, 2013
Accepted: November 1, 2013
Published online: January 21, 2014
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.
Core tip: This study reported the long-term follow-up results of a large cohort of cirrhotic patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) for variceal bleeding. The results demonstrated that the use of the left portal vein (PV) during the TIPS procedure could reduce post-TIPS hepatic encephalopathy risk and improve patient survival when compared to the use of the right PV, and that the deployment of a stent with optimal stent position could reduce the incidence of shunt dysfunction and benefit patient survival when compared to the deployment of a stent with suboptimal stent position.