Published online Jun 26, 2019. doi: 10.12998/wjcc.v7.i12.1410
Peer-review started: March 8, 2019
First decision: April 18, 2019
Revised: April 28, 2019
Accepted: May 11, 2019
Article in press: May 11, 2019
Published online: June 26, 2019
Transfemoral intrahepatic portosystemic shunt (TFIPS) can be performed to treat portal hypertension. However, few studies have evaluated the safety and efficacy of this technique.
To retrospectively evaluate the safety and clinical outcomes of TFIPS and compare them with those of typical transjugular intrahepatic portosystemic shunt (TIPS).
This retrospective study was approved by our hospital ethics committee. From November 2012 to November 2015, 19 patients who underwent successful TFIPS placement were included. In addition, 21 patients treated with TIPS during the same period were selected as controls. Data collected included the success rate and complications of TIPS and TFIPS. Continuous data were expressed as the mean ± SD and were compared using the Student’s t test. All categorical data were expressed as count (percentage) and were compared using the χ2 test or Fisher’s exact test. The Kaplan–Meier method was used to calculate cumulative survival rate and survival curves.
Baseline characteristics were comparable between the two groups. The success rate of TFIPS and TIPS was 95% (19/20) and 100% (21/21), respectively. Effective portal decompression and free antegrade shunt flow was completed in all patients. The portal pressure gradient prior to TIPS and TFIPS placement was 23.91 ± 4.64 mmHg and 22.61 ± 5.39 mmHg, respectively, and it was significantly decreased to 10.85 ± 3.33 mmHg and 10.84 ± 3.33 mmHg after stent placement, respectively. Time–to-event calculated rates of shunt patency at one and two years in the TFIPS and TIPS groups were not statistically different (94.7% vs 95.2% and 94.7% vs 90.5%, respectively). De nova hepatic encephalopathy was 27.5% (11/40) with five patients in the TFIPS group (26.3%) and six patients (28.6%) in the TIPS group experiencing it (P = 0.873). The cumulative survival rates were similar between the two groups: 94.7% and 94.7% at 1 and 2 years, respectively, in the TFIPS group vs 100% and 95.2% at 1 and 2 years, respectively, in the TIPS group (P = 0.942).
TFIPS may be a valuable adjunct to traditional approaches in patients with portal hypertension.
Core tip: Transjugular intrahepatic portosystemic shunt is currently an accepted therapy and has proved beneficial in the treatment of portal hypertension and their complications. However, exceptionally challenging anatomy may require unorthodox salvage techniques, such as transfemoral intrahepatic portosystemic shunt (TFIPS). Because of the rare use of TFIPS, there are few clinical trials that have assessed the safety and effectiveness of TFIPS. In this retrospective study, we describe the TFIPS procedure in detail and evaluate the safety and clinical outcomes of TFIPS and compare them with those of typical transjugular intrahepatic portosystemic shunt. The TFIPS procedure is feasible and efficacy in patients with unorthodox anatomy between the hepatic vein and the portal vein bifurcation.