Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Cardiovasc Intervent Radiol. 2020 Aug;43(8):1156-1164. doi: 10.1007/s00270-020-02512-7. Epub 2020 May 20.
To identify clinical variables, including use of newer Viatorr TIPS endoprosthesis with controlled expansion (VCX) that may affect the occurrence and risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) creation.
A total of 376 patients who underwent TIPS creation at our institution between 2003 and 2018 were retrospectively identified. Of these patients, 71 received a Viatorr controlled expansion endoprosthesis and 305 received a Viatorr TIPS endoprosthesis (older version without controlled expansion). Multivariate regression analysis was used to identify factors predicting the occurrence of hepatic encephalopathy after TIPS creation; a Cox proportional hazard model was used to assess risk of HE through time to HE onset RESULTS: A total of 194 patients (52%) developed hepatic encephalopathy after TIPS creation, including 28 of 71 patients (39%) who received a VCX endoprosthesis. Older patient age and the use of Viatorr endoprosthesis without controlled expansion were significantly associated with the development of hepatic encephalopathy overall. Pre-TIPS pressure variables, patient age, plasma international normalized ratio, and model for end-stage liver disease score were risk factors for time to hepatic encephalopathy.
Several variables are mild predictors of early hepatic encephalopathy development after TIPS creation, and the use of VCX endoprosthesis in TIPS creation is associated with a modest lower risk of hepatic encephalopathy. These preliminary findings should be considered in regard to patient selection, endoprosthesis selection, and post-transjugular intrahepatic portosystemic shunt creation monitoring for the development of hepatic encephalopathy.
确定临床变量，包括使用新型 Viatorr TIPS 支架（带可控扩张），这些因素可能会影响经颈静脉肝内门体分流术（TIPS）后肝性脑病的发生和风险。
回顾性分析了 2003 年至 2018 年在我院接受 TIPS 治疗的 376 例患者。其中，71 例患者接受了 Viatorr 可控扩张支架，305 例患者接受了 Viatorr TIPS 支架（旧版，无可控扩张）。采用多变量回归分析确定预测 TIPS 术后发生肝性脑病的因素；采用 Cox 比例风险模型评估 HE 发病风险与时间的关系。
共有 194 例患者（52%）在 TIPS 术后发生肝性脑病，其中 71 例接受 VCX 支架的患者中有 28 例（39%）发生肝性脑病。老年患者和使用无可控扩张 Viatorr 支架与肝性脑病的发生显著相关。术前压力变量、患者年龄、血浆国际标准化比值和终末期肝病模型评分是肝性脑病发生时间的危险因素。
一些变量是 TIPS 术后早期肝性脑病发展的轻度预测因素，TIPS 中使用 VCX 支架与肝性脑病的风险略低相关。这些初步发现应在患者选择、支架选择和 TIPS 术后监测肝性脑病的发生方面进行考虑。
