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J Gastroenterol Hepatol 2021 May 11. Epub 2021 May 11.

Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Background And Aim: Patients indicated to transjugular intrahepatic portosystemic shunt (TIPS) placement may have splenectomy history due to thrombocytopenia. This study aimed to evaluate the effect of prior splenectomy on TIPS procedure and post-TIPS outcomes.

Methods: We conducted a longitudinal analysis based on a cohort of 284 patients with cirrhosis submitted to TIPS. Read More

Transplant Proc 2021 May 5. Epub 2021 May 5.

Department of Medicine, Emory University, Atlanta, Georgia. Electronic address:

Transjugular intrahepatic portosystemic shunt (TIPS) is well established as a salvage therapy for refractory esophageal variceal hemorrhage (EVH). A more controversial issue is the upper limit of Model for End-Stage Liver Disease (MELD) scores at which this procedure can be performed safely. We present 2 cases of TIPS performed for EVH in patients with severely high MELD scores as a successful intervention for hemostatic and hemodynamic stabilization, and as a bridge to urgent liver transplantation. Read More

Biomed Res Int 2021 17;2021:5530004. Epub 2021 Apr 17.

Department of Ultrasonic Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China 710032.

Objectives: To investigate the performance of spleen stiffness (SS) by using two-dimensional shear-wave elastography (2D-SWE) for assessing the severity of gastroesophageal varices (GEVs) after transjugular intrahepatic portosystemic shunt (TIPS).

Methods: 102 eligible patients were categorized as in the post-TIPS short-term ( = 69) and long-term ( = 38) follow-up groups. The performance of SS by using 2D-SWE for evaluating the severity of GEVs was compared with liver stiffness (LS), spleen stiffness-to-liver stiffness ratio (SS/LS), liver stiffness spleen-diameter-to-platelet-ratio score (LSPS), portal hypertension (PH) risk score, platelet count-to-spleen diameter ratio (PSR), and varices risk score by using receiver operating characteristic (ROC) curve and DeLong test. Read More

BMC Med Inform Decis Mak 2021 May 5;21(1):149. Epub 2021 May 5.

Department of Radiology, Limerick University Hospital, St Nessan's Rd, Dooradoyle, Co. Limerick, V94 F858, Ireland.

Purpose: Transjugular intrahepatic portosystemic shunt (TIPS) procedure is an established procedure carried out by interventional radiologists to achieve portal decompression and to manage the complications of portal hypertension. The aim of this study was to evaluate the quality and readability of information available online for TIPS procedure.

Methods: Websites were identified using the search terms "TIPS procedure", "TIPSS procedure", "transjugular intrahepatic portosystemic shunt procedure", with the first 25 pages from the three most popular search engines (Google, Bing and Yahoo) being selected for evaluation with a total of 225. Read More

Clin Imaging 2021 Apr 29;77:187-192. Epub 2021 Apr 29.

Division of Vascular & Interventional Radiology, Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC 27710, USA. Electronic address:

Purpose: Proton pump inhibitor (PPI) use is a potential risk factor for hepatic encephalopathy (HE), but few studies have examined the effect on post-TIPS HE. The purpose of this study was to determine whether PPIs are associated with increased rates of post-TIPS HE in an independent patient cohort.

Materials And Methods: This single-institution retrospective study analyzed 86 patients (54 male, mean age 58. Read More

Frontline Gastroenterol 2021 15;12(3):232-234. Epub 2020 May 15.

Department of Gastroenterology and Hepatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.

An elderly gentleman with primary sclerosing cholangitis (PSC) was admitted with rectal bleeding, shown on flexible sigmoidoscopy to be arising from rectal varices, which bled despite endoscopic therapy with histoacryl glue. Therapeutic options were limited with surgery and transjugular intrahepatic portosystemic shunt deemed too high risk, and endovascular embolisation through interventional radiology was sought. Coil-assisted retrograde transvenous obliteration was used to good effect. Read More

J Vasc Interv Radiol 2021 Apr 23. Epub 2021 Apr 23.

Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora CO; Department of Radiology, University of Southern California.

Purpose: To investigate the magnitude of racial/ethnic differences in hospital mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation for acute variceal bleeding and whether hospital care processes contribute to them.

Methods: Patients >18 years undergoing TIPS creation for acute variceal bleeding in the United States (n=10,331) were identified in the 10 available years (2007-2016) of the National Inpatient Sample. Hierarchical logistic regression was used to examine the relationship between patient race and inpatient mortality, controlling for disease severity, treatment utilization and hospital characteristics. Read More

Eur Radiol 2021 Apr 24. Epub 2021 Apr 24.

Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, People's Republic of China.

Objectives: This study aims to compare the safety and effectiveness between transarterial chemoembolization (TACE) with drug-eluting beads (DEB-TACE) and conventional TACE (cTACE) using lipiodol-based regimens in HCC patients with a transjugular intrahepatic portosystemic shunt (TIPS).

Methods: This retrospective study included patients with patent TIPS who underwent TACE from January 2013 to January 2019 that received either DEB-TACE (DEB-TACE group, n = 57) or cTACE (cTACE group, n = 62). The complications, liver toxicity, overall survival (OS), time to progression (TTP), and objective response rate (ORR) were compared between the groups. Read More

Cardiovasc Intervent Radiol 2021 Apr 22. Epub 2021 Apr 22.

Department of Radiology, College of Medicine University of Illinois at Chicago, MC 931, 1740 West Taylor Street, Chicago, IL, 60612, USA.

Purpose: To quantify the pooled clinical outcomes of stent-graft transjugular intrahepatic portosystemic shunt (TIPS) creation for the management of gastric varices (GVs) through systematic review of the literature and meta-analysis.

Materials And Methods: A PubMed and Embase search was performed from 2003 to 2020. Search terms included: (transjugular intrahepatic portosystemic shunt OR TIPS) AND (gastric varices OR fundal varices OR gastroesophageal varices OR gastroesophageal varices) AND (hemorrhage OR rebleeding OR rebleeding OR survival). Read More

Eur J Gastroenterol Hepatol 2021 Apr 16. Epub 2021 Apr 16.

Division of Gastroenterology Cardiology Unit Interventional Radiology Unit, San Giovanni Battista Hospital, Turin, Italy.

Background And Aims: Left ventricular diastolic dysfunction (LVDD) in cirrhotics are associated with circulatory dysfunction, hepatorenal syndrome (HRS) and heart failure in stressful conditions. Transjugular intrahepatic portosystemic shunt (TIPS) exacerbates the hyperdynamic circulation and challenges cardiac function. We evaluated the incidence and the impact of LVDD in cirrhotic candidates to TIPS for refractory ascites. Read More

J Vasc Interv Radiol 2021 Apr 14. Epub 2021 Apr 14.

Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address:

Purpose: To evaluate the effectiveness and safety of transjugular intrahepatic portosystemic shunt (TIPS) creation for the prevention of gastric variceal rebleeding in patients with Hepatocellular carcinoma (HCC).

Materials And Methods: This multicenter retrospective study included 126 cirrhotic patients (mean age, 54.1 ± 10. Read More

Hepatol Commun 2021 Apr 5;5(4):650-660. Epub 2021 Jan 5.

Department of Medicine II Medical Center University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany.

Prognostic assessment of patients with liver cirrhosis allocated for implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is a challenging task in clinical practice. The aim of our study was to assess the prognostic value of the CLIF-C AD (Acute Decompensation) score in patients with TIPS implantation. Transplant-free survival (TFS) and 3-month mortality were reviewed in 880 patients who received TIPS implantation for the treatment of cirrhotic portal hypertension. Read More

Pediatr Radiol 2021 Mar 30. Epub 2021 Mar 30.

Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, USA.

Background: Retrospective studies have demonstrated the efficacy and safety of pediatric and adolescent transjugular intrahepatic portosystemic shunt (TIPS), but long-term outcomes warrant further investigation.

Objective: To report on the development of hyperplastic hepatic nodular lesion development in children and young adults (<21 years) with TIPS patency >3 years.

Materials And Methods: Eighteen children and young adults, including 10 (55. Read More

Sci Rep 2021 Mar 29;11(1):7065. Epub 2021 Mar 29.

Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53105, Bonn, Germany.

The puropse of this study was to evaluate associations of cisterna chyli (CCh) diameter with portal hemodynamics and the influence of TIPS-creation in cirrhotic patients. 93 cirrhotic patients (57 male, mean age 59 years) received CT prior to TIPS-creation. 38/93 additionally underwent post-interventional CT. Read More

Eur J Gastroenterol Hepatol 2021 Mar 19. Epub 2021 Mar 19.

Department of Interventional Radiology, Zhongshan Hospital, Fudan University Shanghai Institution of Medical Imaging, Fudan University National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University Center for Tumor Diagnosis and Therapy, Jinshan Hospital, Fudan University, Shanghai, China.

Background: Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) remains an unsolved problem; therefore, this study aimed to compare the efficacy of shunting different portal vein branch during TIPS with 8 mm covered stent for preventing gastroesophageal variceal rebleeding in cirrhotic patients.

Methods: Between November 2015 and December 2018, the medical records of consecutive cirrhotic patients who received TIPS with an 8 mm covered stent for preventing gastroesophageal variceal rebleeding were analyzed retrospectively. Shunting the left and right branches of the portal vein was performed in 58 (group A) and 104 patients (group B), respectively. Read More

Vasc Endovascular Surg 2021 Mar 19:15385744211002026. Epub 2021 Mar 19.

Division of Vascular and Interventional Radiology, Department of Radiology, University of Minneapolis, MN, USA.

Budd-Chiari syndrome (BCS) results from the occlusion or flow reduction in the hepatic veins or inferior vena cava and can be treated with transjugular intrahepatic portosystemic shunt when hepatic vein recanalization fails. Hypercoagulable patients with primary BCS are predisposed to development of new areas of thrombosis within the TIPS shunt or IVC. This case details a patient with BCS, pre-existing TIPS extending to the right atrium, and chronic retrohepatic IVC thrombosis who underwent sharp recanalization of the IVC with stenting into the TIPS stent bridging the patient until his subsequent hepatic transplantation. Read More

AJR Am J Roentgenol 2021 05 11;216(5):1267-1272. Epub 2021 Mar 11.

Department of Radiology, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCC 308-B, 1 Deaconess Rd, Boston, MA 02215.

The purpose of this study was to determine clinical outcomes of patients undergoing TIPS reduction. In this institutional review board-approved, HIPAA-compliant study, all TIPS reductions performed at two institutions from January 1, 2008 to January 31, 2016, were retrospectively identified. Patients were divided into two groups according to pre-TIPS symptoms: volume overload due to ascites or hydrothorax (VO; = 14) or variceal bleeding (VB; = 12). Read More

J Med Imaging Radiat Oncol 2021 Mar 9. Epub 2021 Mar 9.

Hepatology and Transplant Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.

Introduction: Transjugular intrahepatic portosystemic shunt (TIPSS) is an effective modality in reducing portal pressure, and its current main indications are for the management of recurrent ascites and variceal bleeding. The demand and indications for TIPSS are growing. However, it is a complicated and technically demanding procedure with poorer outcomes associated with low volume centres. Read More

J Vasc Interv Radiol 2021 Mar 1. Epub 2021 Mar 1.

Division of Vascular and Interventional Radiology, Department of Radiology, Duke University School of Medicine, Durham. Electronic address:

Purpose: To determine whether socioeconomic status (SES) is associated with hepatic encephalopathy (HE) risk after transjugular intrahepatic portosystemic shunt (TIPS) creation.

Materials And Methods: This single-institution retrospective study included 368 patients (mean age = 56.7 years; n = 229 males) from 5 states who underwent TIPS creation. Read More

Abdom Radiol (NY) 2021 Mar 3. Epub 2021 Mar 3.

Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.

Purpose: Hepatic encephalopathy (HE) is a common complication in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS). The objective of this study was to assess the prognostic factors and make risk stratification of post-TIPS HE.

Methods: This was a retrospective cohort study consisting of cirrhotic patients who had undergone TIPS creation at our center from November 2015 to August 2020. Read More

Dig Dis Sci 2021 Feb 27. Epub 2021 Feb 27.

Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via E. Tricomi 5, 90127, Palermo, Italy.

Am J Gastroenterol 2021 Feb 25. Epub 2021 Feb 25.

Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xi'an International Medical Center Hospital of Digestive Diseases, Northwestern University, Xi'an, China; Department of Liver Diseases and Interventional Radiology, Xi'an International Medical Center Hospital of Digestive Diseases, Northwestern University, Xi'an, China; Department of Ultrasound, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China; State Key Laboratory of Cancer Biology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.

Introduction: Current guidelines recommend anticoagulation as the mainstay of portal vein thrombosis (PVT) treatment in cirrhosis. However, because of the heterogeneity of PVT, anticoagulation alone does not always achieve satisfactory results. This study aimed to prospectively evaluate an individualized management algorithm using a wait-and-see strategy (i. Read More

Frontline Gastroenterol 2021 28;12(2):108-112. Epub 2020 Feb 28.

Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK.

Objective: Refractory ascites is an established indication for liver transplantation. While transplantation is regarded as the definitive therapy for this condition, many patients are unsuitable due to comorbidity or frailty. Alternatives such as transjugular intrahepatic portosystemic shunt (TIPSS) and large-volume paracentesis can lead to complications, including encephalopathy, circulatory and renal dysfunction, and protein-calorie deficiency that may accelerate sarcopenia. Read More

Endoscopy 2021 Feb 16. Epub 2021 Feb 16.

Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany.

Medicine (Baltimore) 2021 Feb;100(6):e24465

Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou.

Abstract: To evaluate the outcomes of the transjugular intrahepatic portosystemic shunt (TIPS) combined with AngioJet thrombectomy in patients with noncirrhotic acute portal vein (PV) thrombosis.Retrospective analysis from January 2014 to March 2017, 23 patients underwent TIPS combined with AngioJet thrombectomy for acute PV thrombosis in noncirrhosis. The rates of technical success, the patency of the PV, liver function changes, and complications were evaluated. Read More

Aliment Pharmacol Ther 2021 03;53(5):677-678

Service des maladies de l'appareil digestif, Hôpital Claude Huriez, CHU Lille, Lille, France.

Aliment Pharmacol Ther 2021 03;53(5):676

Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China.

GE Port J Gastroenterol 2020 Dec 9;28(1):5-12. Epub 2020 Jun 9.

Interventional Radiology Unit, Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal.

Background And Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is used for decompressing clinically significant portal hypertension. The aims of this study were to evaluate clinical outcomes and adverse events associated with this procedure.

Methods: Retrospective single-center study including 78 patients submitted to TIPS placement between January 2015 and November 2018. Read More

Radiol Case Rep 2021 Apr 27;16(4):824-828. Epub 2021 Jan 27.

Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, 702 Rotary Circle Suite 225, Indianapolis, IN 46202, USA.

Portal vein thrombosis (PVT) is an important cause of noncirrhotic portal hypertension. Noncancerous extrinsic compression of portal vein to drive PVT formation is rare, but important to identify. A 64-year-old female with idiopathic hepatic artery pseudoaneurysm (HAPA) rupture 7 months prior presented with acute-onset hematemesis and melena and was found to have prehepatic portal hypertensive variceal bleeding. Read More

Clin Radiol 2021 Apr 4;76(4):287-293. Epub 2021 Feb 4.

Department of Medicine, Division of Gastroenterology, Baylor Scott and White, 3410 Worth St, Ste 860, Dallas, TX 75246, USA.

Aim: To examine the frequency and predictive factors for bowel incarceration following transjugular intrahepatic portosystemic shunts (TIPS) placement to treat refractory cirrhosis-induced ascites.

Materials And Methods: Ninety-nine patients with known hernias at the time of TIPS placement were identified. Their electronic medical records were reviewed and pertinent pre-procedural, procedural, and outcome variables were recorded. Read More