title: Comparison of transjugular intrahepatic portosystemic shunt (TIPS) alone versus TIPS combined with embolotherapy in advanced cirrhosis: a retrospective study.
abstract: OBJECTIVE
  This study was designed to determine whether a transjugular intrahepatic portosystemic shunt (TIPS) combined with embolotherapy was superior to TIPS alone.
  
  
  METHODS
  Seventy-nine patients were included in the study (43 in the TIPS and embolotherapy group and 36 in the TIPS alone group). Embolotherapy was performed after TIPS using coils and a tissue adhesive agent. The portosystemic pressure gradient (PPG) after TIPS was lower than 12 mm Hg in all patients. Multivariate analyses were performed using a Cox regression model, and the probabilities of survival and rebleeding were estimated with the Kaplan-Meier method.
  
  
  RESULTS
  Baseline patient survey data showed similar distributions in both groups. The mean follow-up time was 45.6 months (range: 1 to 85.6 mo). There were no significant differences in the incidences of rebleeding (P=0.889), stent revision (P=0.728), encephalopathy (P=0.728), the cumulative survival rate (P=0.552), or the probability of being free of rebleeding (P=0.806) between the 2 groups. Of 9 patients with rebleeding after TIPS plus embolotherapy, 7 had a history of esophageal variceal bleeding and 2 had gastric variceal bleeding. Of 8 patients with rebleeding after TIPS alone, 4 had a history of esophageal variceal bleeding and 4 had gastric variceal bleeding (P=0.247). Multivariate analysis showed that PPG after TIPS was an independent predictor of rebleeding (P=0.036). Age and Model of End-stage Liver Disease score were independent predictors of survival (P=0.048 and 0.037).
  
  
  CONCLUSIONS
  The results suggest that TIPS with embolotherapy cannot reduce the risk of rebleeding if PPG is less than 12 mm Hg after TIPS. PPG after TIPS is an independent predictor of rebleeding.
authors.affiliation: Department of Gastroenterology, Southwest Hospital, Third Military Medical University, Chongqing, PR of China.
authors.forename: Tianli
authors.initials: T
authors.lastname: Xiao
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.forename: Wensheng
authors.initials: W
authors.lastname: Chen
authors.forename: Baoyan
authors.initials: B
authors.lastname: Xu
authors.forename: Qingling
authors.initials: Q
authors.lastname: Long
authors.forename: Rongjun
authors.initials: R
authors.lastname: Li
authors.forename: Linming
authors.initials: L
authors.lastname: Li
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Peng
authors.forename: Dianchun
authors.initials: D
authors.lastname: Fang
authors.forename: Rongquan
authors.initials: R
authors.lastname: Wang
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000601:surgery / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery / Q000628:therapy; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome