title: Shunting branch of portal vein and stent position predict survival after transjugular intrahepatic portosystemic shunt.
abstract: OBJECTIVE
  To evaluate the effect of the shunting branch of the portal vein (PV) (left or right) and the initial stent position (optimal or suboptimal) of a transjugular intrahepatic portosystemic shunt (TIPS).
  
  
  METHODS
  We retrospectively reviewed 307 consecutive cirrhotic patients who underwent TIPS placement for variceal bleeding from March 2001 to July 2010 at our center. The left PV was used in 221 patients and the right PV in the remaining 86 patients. And, 224 and 83 patients have optimal stent position and sub-optimal stent positions, respectively. The patients were followed until October 2011 or their death. Hepatic encephalopathy, shunt dysfunction, and survival were evaluated as outcomes. The difference between the groups was compared by Kaplan-Meier analysis. A Cox regression model was employed to evaluate the predictors.
  
  
  RESULTS
  Among the patients who underwent TIPS to the left PV, the risk of hepatic encephalopathy (P = 0.002) and mortality were lower (P < 0.001) compared to those to the right PV. Patients who underwent TIPS with optimal initial stent position had a higher primary patency (P < 0.001) and better survival (P = 0.006) than those with suboptimal initial stent position. The shunting branch of the portal vein and the initial stent position were independent predictors of hepatic encephalopathy and shunt dysfunction after TIPS, respectively. And, both were independent predictors of survival.
  
  
  CONCLUSIONS
  TIPS placed to the left portal vein with optimal stent position may reduce the risk of hepatic encephalopathy and improve the primary patency rates, thereby prolonging survival.
authors.affiliation: Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Bai
authors.affiliation: Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Chuang-Ye
authors.initials: CY
authors.lastname: He
authors.affiliation: Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Xing-Shun
authors.initials: XS
authors.lastname: Qi
authors.affiliation: Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Zhan-Xin
authors.initials: ZX
authors.lastname: Yin
authors.affiliation: Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Jian-Hong
authors.initials: JH
authors.lastname: Wang
authors.affiliation: Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Wen-Gang
authors.initials: WG
authors.lastname: Guo
authors.affiliation: Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Niu
authors.affiliation: Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Jie-Lai
authors.initials: JL
authors.lastname: Xia
authors.affiliation: Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Zhuo-Li
authors.initials: ZL
authors.lastname: Zhang
authors.affiliation: Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Larson
authors.affiliation: Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Kai-Chun
authors.initials: KC
authors.lastname: Wu
authors.affiliation: Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Dai-Ming
authors.initials: DM
authors.lastname: Fan
authors.affiliation: Ming Bai, Chuang-Ye He, Xing-Shun Qi, Zhan-Xin Yin, Wen-Gang Guo, Jing Niu, Jie-Lai Xia, Zhuo-Li Zhang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han, Department of Liver Disease and Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Guo-Hong
authors.initials: GH
authors.lastname: Han
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011172:Portography; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cirrhosis; Portal vein; Stent position; Transjugular intrahepatic portosystemic shunt; Variceal bleeding