Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, 44195, USA.
Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
Cardiovasc Intervent Radiol. 2022 Oct;45(10):1512-1523. doi: 10.1007/s00270-022-03219-7. Epub 2022 Jul 18.
To describe the imaging findings of hepatic infarction after transjugular intrahepatic portosystemic shunt (TIPS) placement and identify risk factors, clinical manifestations, and outcomes of infarction after TIPS.
In this retrospective analysis of a TIPS registry (1995-2021), cirrhotic patients with hepatic infarction (n = 33) and control patients without infarct (n = 33) after TIPS were identified. Laboratory values, ultrasound findings, and clinical variables were compared between groups to identify risk factors and differences in outcomes. A Cox proportional hazards regression model with propensity score was used to assess the effect of hepatic infarction on mortality and acute-on-chronic liver failure (ACLF) score.
Hepatic infarction involved the right posterior segments (segments VI or VII) in 32 of 33 patients. Prolonged vasopressor requirement (p = 0.003) and intensive care unit stay (p = 0.001) were seen in patients with hepatic infarct, as well as trends toward lower post-TIPS portosystemic pressure gradient (p = 0.061) and higher risk of ACLF (p = 0.056). Procedure-related portal vein thrombosis or hepatic artery injury was identified in 12 and 5 patients with infarct, respectively. Patients with infarct had higher postprocedural aspartate aminotransferase (p < 0.001) and alanine aminotransferase (p < 0.001) levels, higher international normalized ratio (p = 0.016), lower platelet count (p = 0.042), and a greater decrease in hemoglobin level (p = 0.003).
Hepatic infarction most frequently affects the right posterior hepatic segments after TIPS and results in a worse postprocedural course. Procedure-related complications and critically low portosystemic pressure gradient may contribute to TIPS-associated hepatic infarct.
描述经颈静脉肝内门体分流术（TIPS）后肝梗死的影像学表现，并确定 TIPS 后梗死的危险因素、临床表现和结局。
在这项对 TIPS 登记处（1995-2021 年）的回顾性分析中，确定了 TIPS 后发生肝梗死（n=33）和无梗死（n=33）的肝硬化患者。比较两组之间的实验室值、超声表现和临床变量，以确定危险因素和结局差异。使用倾向评分的 Cox 比例风险回归模型评估肝梗死对死亡率和慢加急性肝衰竭（ACLF）评分的影响。
33 例患者中有 32 例肝梗死累及右后段（VI 或 VII 段）。发生肝梗死的患者需要长时间使用血管加压药（p=0.003）和入住重症监护病房（p=0.001），术后门体压力梯度较低（p=0.061）和 ACLF 风险增加（p=0.056）也呈趋势。12 例和 5 例梗死患者分别发现与操作相关的门静脉血栓形成或肝动脉损伤。梗死患者术后天门冬氨酸转氨酶（p<0.001）和丙氨酸转氨酶（p<0.001）水平更高、国际标准化比值（p=0.016）更低、血小板计数（p=0.042）更低、血红蛋白水平下降更明显（p=0.003）。
TIPS 后肝梗死最常影响右后肝段，导致术后病程恶化。与操作相关的并发症和临界低门体压力梯度可能导致 TIPS 相关的肝梗死。
