title: Recurrent variceal bleeding and shunt patency: prospective randomized controlled trial of transjugular intrahepatic portosystemic shunt alone or combined with coronary vein embolization.
abstract: OBJECTIVE
  To prospectively evaluate the efficacy of a transjugular intrahepatic portosystemic shunt (TIPS) alone and TIPS in association with embolotherapy (TIPS+E) in the variceal coronary vein to prevent recurrent variceal bleeding and stent dysfunction after TIPS creation.
  
  
  METHODS
  Institutional review board approval was obtained; all participants provided informed consent. A total of 106 patients (66 men, 40 women; age range, 18-70 years) with recurrent variceal bleeding due to hepatic cirrhosis were assigned randomly to the TIPS+E (n = 54) or TIPS (n = 52) group from May 2007 to July 2011. The TIPS was created by using covered stents. Patients in the TIPS+E group underwent embolotherapy via the jugular vein before TIPS implantation. Rates of recurrent variceal bleeding, stent patency, and survival were evaluated. Scores for liver function and life quality were calculated.
  
  
  RESULTS
  TIPS placement was successful in all patients. Recurrent variceal bleeding ranked second among causes of death after TIPS placement. Although the 3-year cumulative rates of shunt patency, recurrent variceal bleeding, and survival in the two groups were not significantly different (P > .05), the 6-month overall rate of shunt patency in the TIPS+E group was significantly higher than that in the TIPS group (96.2% vs 82.0%, P = .019), and the 6-month overall rate of recurrent variceal bleeding was also significantly lower than that in the TIPS group (5.7% vs 20.0%, P = .029).
  
  
  CONCLUSIONS
  The TIPS+E regimen may reduce the risk of recurrent variceal bleeding during the first 6 months after the TIPS procedure by preventing shunt dysfunction, which may improve liver function and quality of life. © RSNA, 2013.
authors: Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China.
authors: Shuang
authors: S
authors: Chen
authors: Xiao
authors: X
authors: Li
authors: Bo
authors: B
authors: Wei
authors: Huan
authors: H
authors: Tong
authors: Ming-Guang
authors: MG
authors: Zhang
authors: Zhi-Yin
authors: ZY
authors: Huang
authors: Jia-Wei
authors: JW
authors: Cao
authors: Cheng-Wei
authors: CW
authors: Tang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D003131:Combined Modality Therapy / Q000401:mortality; D004621:Embolization, Therapeutic / Q000401:mortality*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000401:mortality*; D015995:Prevalence; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency; D055815:Young Adult