Primary Constrained Transjugular Intrahepatic Portosystemic Shunt Placement: A Technique to Manage Risk of Encephalopathy

Purpose To report an initial experience using a primary constrained transjugular intrahepatic portosystemic shunt (TIPS) technique for treating cirrhotic patients with refractory ascites or variceal bleeding.

Materials and Methods All patients undergoing primary constrained (n = 9) and conventional (n = 18) TIPS between July 2014 and June 2016 were retrospectively reviewed. Pre-procedure demographics, Child–Pugh (CP), Model for End-Stage Liver Disease (MELD), and technical variables were recorded. Outcomes measured included technical and clinical success, complications, 30-day mortality, as well as necessity for TIPS revision. Average (standard deviation [SD]) and median follow-up was 237 (190) and 226 days, respectively.

Results All constrained and conventional TIPS were technically successful (100%). Clinical success as defined as a reduction or improvement in presenting symptoms were 88.9% (8/9) and 100% (18/18) in the constrained and conventional groups, respectively (p = 1). The average reduction in portosystemic gradient was lower in the constrained group, 6.1 mm Hg compared with 10.6 mm Hg in the conventional group (p = 0.73). The rate of hepatic encephalopathy following TIPS placement was higher in the conventional group 16.7% (3/18) compared with 0% in the constrained group (p = 0.52). The percentage of patients requiring TIPS revision was lower in the constrained group, although the results were not significant (11.1% vs 22.2%, p = 0.63).

Conclusion Primary constrained TIPS is a feasible modification to conventional TIPS with similar technical and clinical success rates. A trend toward a smaller reduction in the portosystemic gradient and less need for revision was observed in the constrained group.