Parallel transjugular intrahepatic portosystemic shunt with Viatorr® stents for primary TIPS insufficiency: Case series and review of literature

Table 1 Laboratory values, Child-Pugh class, model for end-stage liver disease score and medications given for hepatic encephalopathy of patient 1, 2, and 3 before the transjugular intrahepatic portosystemic shunts placement, before the parallel placement, and 6-mo follow-up

Status	Patient 1	Patient 2	Patient 3
Before TIPS	Child-Pugh B; MELD 11; bilirubin 1.1, INR 1.5, PTT 18.6, albumin 2.6; DV post TIPS: 153 (TIPS), 33 cm/s (MPV). Lactulose 10 g/d	Child-Pugh B; MELD 11; bilirubin 0.7, INR 1.3, PTT 16.6, and albumin 3.5. Rifaximin 550 mg × 2/d, Lactulose 20 g × 3/d	Child-Pugh C; MELD 12; bilirubin 1.6, INR 1.4, PTT 17.1, and albumin 2.5; DV immediately post-TIPS: 96 (TIPS), 89.5 cm/s (MPV). Rifaximin 550 mg × 2/d, Lactulose 30 g/45 mL × 3/d
Before PS	Child-Pugh B; MELD 15; bilirubin 4.6, INR 1.3, PTT 17.0, and albumin 2.5; DV: 155 (TIPS), 18 cm/s (MPV). Rifaximin 550 mg × 2/d Lactulose 10 g/d	Child-Pugh B; MELD 10; bilirubin 0.7, INR 1.4, PTT 17.1, and Albumin 2.1; DV 2 wk post-PS: 147 (TIPS), 138 (PS), and 16 cm/s (MPV). Rifaximin 550 mg × 2/d, Lactulose 20 g × 3/d	Child-Pugh C; MELD 13; bilirubin 0.7, INR 1.4, PTT 17.1, and Albumin 2.5; DV: 90.9 (TIPS) 37 cm/s (MPV). Rifaximin 550 mg × 2/d, Lactulose (20 g) 30 mL × 3/d, Piperacillin 4.5 g/6 h
6 mo post-PS	Child-Pugh B; MELD 21; bilirubin 4.5, INR 1.3, PTT 16.5, and albumin 3.5; DV: 78 (TIPS), 144 (PS), 39.3 cm/s (MPV). Rifaximin 550 mg × 2/d Lactulose 10 g/d	Child-Pugh B; MELD 21; bilirubin 2.5, INR 1.5, PTT 18.5, and albumin 2.8; DV: 85.8 (TIPS), 109 (PS), and 83 cm/s (MPV). Rifaximin 550 mg × 2/d, Lactulose 20 g × 3/d	Child-Pugh C; MELD 14; bilirubin 2.1, INR 1.3, PTT 16.7, and albumin 2.0; DV: 72 (TIPS), 92 (PS), and 68 (MPV) cm/s. Rifaximin 550 mg × 2/d, Lactulose (20 g) 30 mL × 3/d

Doppler velocities of the transjugular intrahepatic portosystemic shunts, parallel stent, and main portal vein were also measured. Laboratory values include total bilirubin, international normalized ratio, partial thromboplastin time, and albumin. TIPS: Transjugular intrahepatic portosystemic shunts; PS: Parallel stent; MELD: Model for end-stage liver disease; DV: Doppler velocities; MPV: Main portal vein; INR: International normalized ratio; PTT: Partial thromboplastin time.