Keshava Shyamkumar N, Moses Vinu, Sharma Anand, Ahmed Munawwar, Narayanan Sathya, Padmanabhan Aswin, Goel Ashish, Zachariah Uday, Eapen C E
Department of Interventional Radiology, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Radiol Imaging. 2021 Nov 30;31(4):858-866. doi: 10.1055/s-0041-1735928. eCollection 2021 Oct.
The aim of the study is to evaluate the technical and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) performed with additional transabdominal ultrasound guidance. Patients who underwent TIPS between January 2004 to January 2020 in our center were studied. Technical, hemodynamic, angiographic, and clinical outcome were recorded up to 1 year of follow-up. TIPS was attempted in 162 patients (median [range] age 37[3-69] years; 105 were males and 57 were females; Etiology: Budd-Chiari syndrome [BCS] 91, cirrhosis 65, symptomatic acute portal venous thrombosis [PVT] 3, veno-occlusive disease [VOD] 2, congenital portosystemic shunt [CPSS] 1) during the study period. Indication for TIPS was refractory ascites in 135 patients (BCS 86, cirrhosis 49) and variceal bleed in 21 patients (BCS 5, cirrhosis 16). Technical success was seen in 161 of the 162 (99.4%) patients. The tract was created from hepatic vein in 55 patients and inferior vena cava (IVC) in 106 patients. Complications within 1 week post TIPS were seen in 29 of the 162 (18%) patients, of whom one developed unexplained arrhythmia and hypotension and died. Of the patients with available follow-up, clinical success was noted in 120 (81%), while 14 (9%) patients had partial nonresponse and six (4%) had complete nonresponse. Eight (5%) patients died during the follow-up period. The technical success of TIPS creation with additional transabdominal ultrasound guidance is very high with low peri-procedural complication rate. It has enabled the inclusion of a wider spectrum of cases like acute PVT and obliterated hepatic veins which were otherwise considered contraindications.
本研究的目的是评估在经腹超声引导下进行经颈静脉肝内门体分流术（TIPS）的技术和临床效果。 对2004年1月至2020年1月期间在本中心接受TIPS的患者进行了研究。记录技术、血流动力学、血管造影和临床结果，随访时间长达1年。 在研究期间，对162例患者尝试进行TIPS（年龄中位数[范围]为37[3 - 69]岁；男性105例，女性57例；病因：布加综合征[BCS]91例，肝硬化65例，有症状的急性门静脉血栓形成[PVT]3例，肝静脉闭塞性疾病[VOD]2例，先天性门体分流[CPSS]1例）。TIPS的适应证为135例患者的难治性腹水（BCS 86例，肝硬化49例）和21例患者的静脉曲张出血（BCS 5例，肝硬化16例）。162例患者中有161例（99.4%）获得技术成功。55例患者的分流道由肝静脉建立，106例患者的分流道由下腔静脉（IVC）建立。162例患者中有29例（18%）在TIPS术后1周内出现并发症，其中1例出现不明原因的心律失常和低血压并死亡。在有随访资料的患者中，120例（81%）临床成功，14例（9%）部分无反应，6例（4%）完全无反应。8例（5%）患者在随访期间死亡。 在经腹超声引导下进行TIPS创建的技术成功率很高，围手术期并发症发生率低。它使得能够纳入更广泛的病例，如急性PVT和闭塞的肝静脉，否则这些病例会被视为禁忌证。
