Outcomes of transjugular intrahepatic portosystemic shunt through the left branch vs. the right branch of the portal vein in advanced cirrhosis: a randomized trial.

BACKGROUND/AIMS: The transjugular intrahepatic portosystemic shunt (TIPS) is technically divided into TIPS through the left branch of the portal vein (TIPS-LBPV) and TIPS through the right branch of the portal vein (TIPS-RBPV). In order to compare their advantages and disadvantages, this randomized, controlled trial was designed to investigate their outcomes in advanced cirrhotic patients.

METHODS

Seventy-two patients were randomly placed into TIPS-LBPV (36 patients) and TIPS-RBPV (36 patients, with four failures) groups, and they were prospectively followed for 2 years after TIPS implantation.

RESULTS

Patients who underwent the two different kinds of TIPS were balanced during recruitment for this study. The incidences of overall encephalopathy and de novo encephalopathy in the TIPS-LBPV group were significantly lower than that of the TIPS-RBPV group during follow-up (P=0.036 and 0.012 respectively). The incidences of rebleeding or re-intervention and improvement of ascites were similar between groups (P>0.05). Patients undergoing TIPS-RBPV required more rehospitalization and incurred more costs than those who underwent TIPS-LBPV (P=0.030 and 0.039 respectively). There was no significant difference between the two groups in survival based on a survival curve constructed according to the Kaplan-Meier method (P>0.05).

CONCLUSION

Patients undergoing TIPS-LBPV had a lower incidence of encephalopathy, less rehospitalization and lower costs after TIPS implantation compared with patients undergoing TIPS-RBPV.