title: TIPS for treatment of variceal hemorrhage: clinical outcomes in 128 patients at a single institution over a 12-year period.
abstract: OBJECTIVE
  To assess clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) treatment of variceal hemorrhage.
  
  
  METHODS
  A total of 128 patients (82 men and 46 women; mean age, 52 y) with liver cirrhosis and refractory variceal hemorrhage underwent TIPS creation from 1998 to 2010. Mean Child-Pugh and Model for End-stage Liver Disease (MELD) scores were 9 and 18, respectively. From 1998 to 2004, 12-mm Wallstents (n = 58) were used, whereas from 2004 to 2010, 10-mm VIATORR covered stent-grafts (n = 70) were used. Technical success, hemodynamic success, complications, shunt dysfunction, recurrent bleeding, and overall survival were assessed.
  
  
  RESULTS
  Technical and hemodynamic success rates were 100% and 94%, respectively. Mean portosystemic gradient reduction was 13 mm Hg. Complications at 30 days included encephalopathy (14%), renal failure (5.5%), infection (1.6%), and liver failure (0.8%). Shunt patency rates were 93%, 82%, and 60% at 30 days, 1 year, and 2 years, respectively. Dysfunction, or loss of TIPS primary patency, occurred more with Wallstent versus VIATORR TIPSs (29% vs 11%; P = .009). Recurrent bleeding incidences were 9%, 22%, and 29% at 30 days, 1 year, and 2 years, respectively, and were similar between Wallstent and VIATORR TIPSs (19% vs 19%; P = .924). Variceal embolization significantly reduced recurrent bleeding rates (5% vs 25%; P = .013). Overall survival rates were 80%, 69%, and 65% at 30 days, 1 year, and 2 years, respectively, and were similar between Wallstent and VIATORR TIPSs (35% vs 26% mortality rate; P = .312). Advanced MELD score was associated with increased mortality on multivariate analysis.
  
  
  CONCLUSIONS
  Wallstent and VIATORR TIPSs effectively treat variceal hemorrhage, particularly when accompanied by variceal embolization. Although TIPS with a VIATORR device showed improved shunt patency, patient survival is similar to that with Wallstent TIPS. These results further validate TIPS creation for refractory variceal bleeding.
authors.affiliation: Department of Radiology/Interventional Radiology Section, University of Illinois Medical Center at Chicago, 1740 W. Taylor St., MC 931, Chicago, IL 60612, USA. rongaba@yahoo.com
authors.forename: Ron C
authors.initials: RC
authors.lastname: Gaba
authors.forename: Benedictta O
authors.initials: BO
authors.lastname: Omene
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Podczerwinski
authors.forename: M Grace
authors.initials: MG
authors.lastname: Knuttinen
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Cotler
authors.forename: Eric R
authors.initials: ER
authors.lastname: Kallwitz
authors.forename: Jaime L
authors.initials: JL
authors.lastname: Berkes
authors.forename: Natasha M
authors.initials: NM
authors.lastname: Walzer
authors.forename: James T
authors.initials: JT
authors.lastname: Bui
authors.forename: Charles A
authors.initials: CA
authors.lastname: Owens
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D004932:Esophageal and Gastric Varices / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome