Emergency transjugular intrahepatic portosystemic shunt (TIPS): results, complications and predictors of mortality in the first month of follow-up

• Published in: Radiologia medica 2012-02, Vol.117 (1), p.46-53
• Main Authors: Gazzera, C., Righi, D., Doriguzzi Breatta, A., Rossato, D., Camerano, F., Valle, F., Gandini, G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Creatinine - blood; Diagnostic Radiology; Emergency Treatment; Esophageal and Gastric Varices - mortality; Esophageal and Gastric Varices - surgery; Female; Follow-Up Studies; Humans; Imaging; Interventional Radiology; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Platelet Count; Portasystemic Shunt, Transjugular Intrahepatic - adverse effects; Portasystemic Shunt, Transjugular Intrahepatic - mortality; Postoperative Complications - epidemiology; Predictive Value of Tests; Prognosis; Prothrombin Time; Radiologia Vascolare ed Interventistica; Radiology; Retrospective Studies; Treatment Outcome; Ultrasound; Vascular and Interventional Radiology; Venous Pressure
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-011-0682-9

Purpose We conducted a single-centre retrospective analysis of the results and predictors of early mortality in emergency transjugular intrahepatic portosystemic shunt (TIPS). Materials and methods Between 1992 and 2009, 82 patients with refractory variceal bleeding underwent emergency TIPS at our Institution. The success and complications of the procedure were assessed for each patient. Child class, platelet count, prothrombin time, serum creatinine levels and venous pressure before and after TIPS were studied statistically as possible prognostic factors of early mortality. Results The technical, haemodynamic, and clinical success rates were 91.6%, 78% and 86.6%, respectively. Complications occurred in 21 cases (25.6%): eight were major (two stent migrations, one pulmonary embolism, one haemoperitoneum, one haemobilia, three intrahepatic haematomas) and 13 were minor (encephalopathy responsive to medical therapy). Twenty-one patients (25.6%) died due to the following causes: disseminated intravascular coagulation (DIC) (n=2), haemorrhage (n=8), cardiopulmonary failure (n=2) and liver failure (n=9). The predictors of mortality were Child’s class C, high serum creatinine and prolonged prothrombin time. Conclusions The technical success of TIPS may not lead to haemodynamic and clinical success. Complications are often due to impaired coagulation and inadequacy of the stent-graft. Early mortality is only influenced by pre-existing clinical and laboratory factors.