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
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.
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.
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.
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.
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.
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.
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.