Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2019; 25(9): 1088-1099
Published online Mar 7, 2019. doi: 10.3748/wjg.v25.i9.1088
Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy
Shi-Hua Luo, Jian-Guo Chu, He Huang, Guo-Rui Zhao, Ke-Chun Yao
Shi-Hua Luo, Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
Jian-Guo Chu, He Huang, Department of Radiology, Air Force Medical Center of PLA, Beijing 100142, China
Guo-Rui Zhao, Department of Interventional Radiology, Henan Provincial Infectious Disease Hospital, Zhengzhou 450015, Henan Province, China
Ke-Chun Yao, Department of Ultrasound, Air Force Medical Center of PLA, Beijing 100142, China
Author contributions: Chu JG designed the research; Luo SH and Huang H performed the research; Zhao GR analyzed the data; Luo SH and Huang H wrote the paper; Yao KC revised the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Air Force Medical Center of PLA, Beijing, China.
Informed consent statement: This is a retrospective study, and informed written consent was thus waived.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian-Guo Chu, MD, Professor, Department of Radiology, Air Force Medical Center of PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China. cjgchina@126.com
Telephone: +86-15611161272 Fax: +86-10-66928523
Received: November 16, 2018
Peer-review started: November 16, 2018
First decision: January 6, 2019
Revised: January 24, 2019
Accepted: January 28, 2019
Article in press: January 28, 2019
Published online: March 7, 2019
Abstract
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%, χ2 = 4.839, P = 0.028), 3 mo (12.48% vs 34.20%, χ2 = 5.054, P = 0.025), 6 mo (10.03% vs 32.24%, χ2 = 6.560, P = 0.010), 9 mo (9.17% vs 31.27%, χ2 = 5.357, P = 0.021), and 12 mo (8.21% vs 28.01, χ2 = 3.848, P = 0.051). There were no significant differences between groups A and B at 3 years (6.61% vs 7.16%, χ2 = 1.204, P = 0.272) and 5 years (5.01% vs 6.18%, χ2 = 0.072, P = 0.562). The total survival rate did not differ between groups A and B (χ2 = 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.

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

Core tip: We studied a large cohort of patients with cirrhosis who underwent transjugular intrahepatic portosystemic shunt for recurrent variceal bleeding and/or ascites. Targeted puncture of the left branch of the intrahepatic portal vein during transjugular intrahepatic portosystemic shunt did not directly influence the prognosis of portal-hypertension-related complications of refractory ascites or variceal bleeding but may reduce the risk of hepatic encephalopathy.