Division of Vascular & Interventional Radiology, Department of Radiology, Duke University Medical Center, 2311, Erwin Road, 27710 Durham, NC, United States.
Vascular Institute, Teton Radiology, Idaho Falls, ID, United States.
Diagn Interv Imaging. 2017 Dec;98(12):837-842. doi: 10.1016/j.diii.2017.07.006. Epub 2017 Aug 31.
The purpose of this study was to assess the incidence of major hemorrhage after transjugular intrahepatic portosystemic shunt (TIPS) insertion using a stent graft at the main portal vein bifurcation.
TIPS insertion using stent grafts was performed in 215 patients due to non-variceal hemorrhage indications. There were 137 men and 78 women, with a mean age of 57 years±10.6 (SD) (range: 19-90 years). Based on retrospective review of portal venograms, TIPS inserted within 5mm from the portal vein bifurcation were considered "bifurcation TIPS", while those inserted 2cm or greater from the bifurcation were considered intrahepatic. Suspicion for acute major periprocedural hemorrhage were categorized as low, moderate, and high, based on the number of signs of hemorrhage.
Of 215 TIPS inserted for purposes other than hemorrhage, the TIPS was inserted at the portal bifurcation in 41 patients (29 men, 12 women; mean age, 55.9±11.7 (SD); range: 26-79 years) and intrahepatic in 62 patients (37 men, 25 women; mean age, 57.6±10.6 (SD), range: 34-82 years), whereas 112 were indeterminate in location. No active extravasations were identified on post-TIPS portal venograms. Suspicion for acute major hemorrhage was moderate or high in 3/41 (7%) of patients in the TIPS bifurcation group compared to 5/62 (8%) in the intrahepatic TIPS group (P>0.99). There were no significant differences in 30-day mortality rates (1/41 [2%] and 3/62 [5%] respectively; P> 0.99). No deaths or interventions were attributed to acute hemorrhage.
TIPS insertion at the portal bifurcation with stent grafts did not incur an elevated risk of hemorrhagic complications.
本研究旨在评估经颈静脉肝内门体分流术（TIPS）中使用门静脉分叉处支架移植物后发生主要出血的发生率。
因非静脉曲张性出血指征，215 例患者行 TIPS 插入术，其中 137 例为男性，78 例为女性，平均年龄 57 岁±10.6（标准差）（范围：19-90 岁）。基于门静脉造影的回顾性分析，将 TIPS 插入距门静脉分叉处 5mm 以内的病例定义为“分叉 TIPS”，而插入距离分叉处 2cm 或更远的病例定义为肝内 TIPS。根据出血征象的数量，将急性围手术期大出血的可疑程度分为低、中和高。
在 215 例因非出血原因而行 TIPS 的患者中，41 例（29 例男性，12 例女性；平均年龄 55.9±11.7（标准差）；范围：26-79 岁）TIPS 插入于门静脉分叉处，62 例（37 例男性，25 例女性；平均年龄 57.6±10.6（标准差），范围：34-82 岁）位于肝内，112 例位置不确定。TIPS 术后门静脉造影未见明显外渗。TIPS 分叉组中，3/41（7%）例患者怀疑有急性大出血，而肝内 TIPS 组中，5/62（8%）例患者怀疑有急性大出血（P>0.99）。两组 30 天死亡率无显著差异（分别为 1/41[2%]和 3/62[5%]；P>0.99）。无死亡或干预归因于急性出血。
使用支架移植物在门静脉分叉处行 TIPS 插入术不会增加出血并发症的风险。
