Short-term complications after TIPS-implantation in patients with liver cirrhosis and portal hypertension

T Bucsics; M Feldner-Busztin; M Diermayr; P Schwabl; M Mandorfer; F Karnel; J Karner; B Angermayr; M Cejna; W Sieghart; A Ferlitsch; M Peck-Radosavljevic; T Reiberger

doi:10.1055/s-0035-1551771

Zeitschrift für Gastroenterologie, Inhaltsverzeichnis

Short-term complications after TIPS-implantation in patients with liver cirrhosis and portal hypertension

T Bucsics ¹^,², M Feldner-Busztin ¹^,², M Diermayr ¹^,², P Schwabl ¹^,², M Mandorfer ¹^,², F Karnel ³, J Karner ⁴, B Angermayr ¹, M Cejna ⁵, W Sieghart ¹^,², A Ferlitsch ¹^,², M Peck-Radosavljevic ¹^,², T Reiberger ¹^,²

¹Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, klinische Abteilung für Gastroenterologie und Hepatologie, Wien, Austria
²Medizinische Universität Wien, Vienna Hepatic Hemodynamic Laboratory, Wien, Austria
³Sozialmedizinisches Zentrum Süd – Kaiser-Franz-Josef-Spital, Abteilung für interventionelle Radiologie, Wien, Austria
⁴Sozialmedizinisches Zentrum Süd – Kaiser-Franz-Josef-Spital, Abteilung für Chirurgie, Wien, Austria
⁵Landeskrankenhaus Feldkirch, Abteilung für Radiologie, Wien, Austria

Abstract

Background and aims:

Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for patients with cirrhosis and complications of portal hypertension. Improvements in materials and techniques have reduced complications after TIPS implantation, but recent data are missing.

Patients and methods:

Consecutive patients with cirrhosis and portal hypertension undergoing TIPS implantation at two major centers in Vienna (center 1: 1994 – 2014, center 2: 1994 – 2005) were retrospectively included. Short-term complications (within 7 days after TIPS implantation) including procedure-related bleedings, infections, hepatic encephalopathy (HE) and mortality were recorded.

Results:

The overall technical success rate was 98% (n = 526/535). Bare-metal stents were implanted in 235 patients (45%) and ePTFE stents in 291 patients (55%). Short-term complications were similar among both groups (P = 0.539). Early complications occurred in 8.9% (n = 47) of all patients within the first week after TIPS implantation and included bleeding in 3.2% (n = 17) and infections in 2.5% (n = 13). In total, 45% (n = 234) developed HE grades III or IV any time during follow-up. Significantly more patients with bare metal stents needed revisions than those with ePTFE-stents [n = 94 (40%) vs. n = 81 (28%), respectively, P = 0.002]. In-hospital mortality was 8% (n = 44), and 1-year mortality was 26% (n = 134).

Conclusion:

Technical success rate was very high in our patient cohort and short-term complications occurred in less than 10%. With approximately 45%, hepatic encephalopathy was the most common complication after TIPS-implantation. Due to a higher patency rate, ePTFE-covered stents needed fewer revisions during follow-up than bare-metal stents.