Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2019; 7(12): 1410-1420
Published online Jun 26, 2019. doi: 10.12998/wjcc.v7.i12.1410
Safety and efficacy of transfemoral intrahepatic portosystemic shunt for portal hypertension: A single-center retrospective study
Yu Zhang, Fu-Quan Liu, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He
Yu Zhang, Fu-Quan Liu, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100010, China
Author contributions: Liu FQ designed the research; Yue ZD, Zhao HW, Wang L, Fan ZH and He FL performed the research; Zhang Y analyzed the data and wrote the paper; Liu FQ critically revised the manuscript for important intellectual content.
Supported by Capital Health Development Scientific Research Project, No. 2018-1-2081.
Institutional review board statement: All patients involved in this study gave their informed consent. Institutional review board approval of our hospital was obtained for this study.
Informed consent statement: Written informed consent was waived from all subjects in this study.
Conflict-of-interest statement: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Open-Access: This article is an open-access article which 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:
Corresponding author: Fu-Quan Liu, BCPS, MD, Director, Professor, Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, No. 10 Tie Yi Road, Yangfangdian, Haidian District, Beijing 100010, China.
Telephone: +86-13701179758
Received: March 8, 2019
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
Research background

Transjugular intrahepatic portosystemic shunts (TIPS) have been used successfully for the treatment of portal hypertension and their complications, such as bleeding varices and refractory ascites. TIPS creation is a percutaneous image-guided procedure in which a decompressive channel is created between a hepatic vein and an intrahepatic branch of the portal vein to reduce portal vein pressure.

Research motivation

TIPS are currently used for the treatment of complications of portal hypertension. With advances in materials, many experimental and clinical studies have been indicated that using covered stent grafts, especially polytetrafluoroethylene covered stent graft, could improve the long-term patency of TIPS. In most situations, a shunt between the hepatic and portal veins can be successfully connected from an internal jugular vein access. Rarely, occlusion of the central veins, hepatic veins, or the vena cava precludes a conventional approach. We used an uncon-ventional procedure called transfemoral intrahepatic portosystemic shunt (TFIPS) to treat portal hypertension and compare this procedure to the traditional approach. In the future, further studies are needed to verify our results.

Research objectives

The main objective was to evaluate the safety and clinical outcomes of TFIPS and compare them with those of TIPS. If TFIPS procedure is as safe and effective as typical TIPS, we should use TFIPS in the patients who are not suitable for the traditional TIPS.

Research methods

In this one center retrospective study,the subjects were patients diagnosed with portal hypertension who underwent TFIPS (19 patients) because of anatomic reasons and TIPS (21 patients). Patient characteristics, technical success rate, hemodynamic changes, the incidence of shunt stenosis, the incidence of hepatic encephalopathy, hepatic myelopaphy (HM) and the survival rate were compared between the two groups.

Research results

This study showed that TFIPS is as effective as TIPS in decompressing portal venous pressure. The TFIPS procedure time is obviously longer than TIPS. There was no significant difference in the incidence of shunt stenosis, hepatic encephalopathy, hepatic myelopaphy and the survival time.

Research conclusions

We found that the TFIPS is as effective as TIPS in treating portal hypertension without increasing the complications of TIPS procedure. TFIPS may be a valuable adjunct to traditional approaches in patients with portal hypertension.

Research perspectives

Because this study used a single-center retrospective design and included relatively few patients, further investigations, such as a multi-center randomized controlled study, are needed. In addition, due to the increased time used in TFIPS procedure, methods to reduce procedure time are needed.