title: Combined transjugular intrahepatic portosystemic shunt and other interventions for hepatocellular carcinoma with portal hypertension.
abstract: OBJECTIVE
  To evaluate combination transjugular intrahepatic portosystemic shunt (TIPS) and other interventions for hepatocellular carcinoma (HCC) and portal hypertension.
  
  
  METHODS
  Two hundred and sixty-one patients with HCC and portal hypertension underwent TIPS combined with other interventional treatments (transarterial chemoembolization/transarterial embolization, radiofrequency ablation, hepatic arterio-portal fistulas embolization, and splenic artery embolization) from January 1997 to January 2010 at Beijing Shijitan Hospital. Two hundred and nine patients (121 male and 88 female, aged 25-69 years, mean 48.3 ± 12.5 years) with complete clinical data were recruited. We evaluated the safety of the procedure (procedure-related death and serious complications), change of portal vein pressure before and after TIPS, symptom relief [e.g., ascites, hydrothorax, esophageal gastric-fundus variceal bleeding (EGVB)], cumulative rates of survival, and distributary channel restenosis. The characteristics of the patients surviving ≥ 5 and < 5 years were also analyzed.
  
  
  RESULTS
  The portosystemic pressure was decreased from 29.0 ± 4.1 mmHg before TIPS to 18.1 ± 2.9 mmHg after TIPS (t = 69.32, P < 0.05). Portosystemic pressure was decreased and portal hypertension symptoms were ameliorated. During the 5 year follow-up, the total recurrence rate of resistant ascites or hydrothorax was 7.2% (15/209); 36.8% (77/209) for EGVB; and 39.2% (82/209) for hepatic encephalopathy. The cumulative rates of distributary channel restenosis at 1, 2, 3, 4, and 5 years were 17.2% (36/209), 29.7% (62/209), 36.8% (77/209), 45.5% (95/209) and 58.4% (122/209), respectively. No procedure-related deaths and serious complications (e.g., abdominal bleeding, hepatic failure, and distant metastasis) occurred. Moreover, Child-Pugh score, portal vein tumor thrombosis, lesion diameter, hepatic arterio-portal fistulas, HCC diagnosed before or after TIPS, stent type, hepatic encephalopathy, and type of other interventional treatments were related to 5 year survival after comparing patient characteristics.
  
  
  CONCLUSIONS
  TIPS combined with other interventional treatments seems to be safe and efficacious in patients with HCC and portal hypertension.
authors.affiliation: Bin Qiu, Meng-Fei Zhao, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Shan Dai, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Qiu
authors.affiliation: Bin Qiu, Meng-Fei Zhao, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Shan Dai, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors.forename: Meng-Fei
authors.initials: MF
authors.lastname: Zhao
authors.affiliation: Bin Qiu, Meng-Fei Zhao, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Shan Dai, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors.forename: Zhen-Dong
authors.initials: ZD
authors.lastname: Yue
authors.affiliation: Bin Qiu, Meng-Fei Zhao, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Shan Dai, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Zhao
authors.affiliation: Bin Qiu, Meng-Fei Zhao, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Shan Dai, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Bin Qiu, Meng-Fei Zhao, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Shan Dai, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors.forename: Zhen-Hua
authors.initials: ZH
authors.lastname: Fan
authors.affiliation: Bin Qiu, Meng-Fei Zhao, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Shan Dai, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors.forename: Fu-Liang
authors.initials: FL
authors.lastname: He
authors.affiliation: Bin Qiu, Meng-Fei Zhao, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Shan Dai, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors.forename: Shan
authors.initials: S
authors.lastname: Dai
authors.affiliation: Bin Qiu, Meng-Fei Zhao, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Shan Dai, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors.forename: Jian-Nan
authors.initials: JN
authors.lastname: Yao
authors.affiliation: Bin Qiu, Meng-Fei Zhao, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Shan Dai, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors.forename: Fu-Quan
authors.initials: FQ
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D002681:China; D049448:Cholangiopancreatography, Magnetic Resonance; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Hepatocellular carcinoma; Interventional treatment; Portal hypertension; Transjugular intrahepatic portosystemic shunt