title: Evaluation of mid- and long-term efficacy of shunt limiting for hepatic myelopathy after transjugular intrahepatic portosystemic shunt.
abstract: BACKGROUND
  Hepatic myelopathy (HM) is a rare condition caused by severe liver dysfunction, and may be secondary to transjugular intrahepatic portosystemic shunt (TIPS). This study aimed to evaluate the mid- and long-term clinical efficacy of TIPS reduction (TIPSR) for treatment of HM secondary to TIPS.
  
  
  METHODS
  Patients who underwent TIPS (n=1325) for severe portal hypertension between August 2002 and August 2013 at the Affiliated Beijing Millennium Monument Hospital, Capital Medical University (Beijing, China) were reviewed. During follow-up, 22 patients were diagnosed with HM, and 12 underwent TIPSR. Patients were evaluated using the Barthel index (daily activities), the Lovette's Six Classification (lower extremity muscle strength), and the Fugl-Meyer assessment (FMA; lower extremity activity). Hepatic encephalopathy grade was used to assess the severity of clinical symptoms.
  
  
  RESULTS
  TIPSR did not affect portal vein pressure (31.6±6.2 vs. 33.3±7.9mmHg, P=0.55). Blood ammonia levels were 77.9±17.9mmol/L before TIPSR and 77.9±14.8, 73.5±21.5, 59.5±14.5, and 52.0±16.5mmol/L at 1, 3, 6, and 12months (P<0.05 for 6 and 12months vs. baseline). The Barthel index was improved 6months after TIPSR (42.1±10.5 vs. 45.0±8.8, P<0.05), while FMA was improved 3months after TIPSR only (24.6±3.2 vs. 25.5±3.2, P<0.05). Lovette's Six Classification was improved 12months after TIPSR (2.1±0.7 vs. 2.8±0.9, P<0.05). After TIPS, hepatic encephalopathy grade was I (n=3), II (n=6), III (n=2), or IV (n=1), and was I (n=8), II (n=1), or III (n=1) at 6months.
  
  
  CONCLUSIONS
  TIPSR can improve the mid- and long-term symptoms of HM secondary to TIPS.
authors.affiliation: Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing 100038, China.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing 100038, China. Electronic address: hongweizhao2014@163.com.
authors.forename: Fuquan
authors.initials: F
authors.lastname: Liu
authors.affiliation: Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing 100038, China.
authors.forename: Zhendong
authors.initials: Z
authors.lastname: Yue
authors.affiliation: Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing 100038, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing 100038, China.
authors.forename: Zhenhua
authors.initials: Z
authors.lastname: Fan
mesh_terms: D000328:Adult; D000368:Aged; D000641:Ammonia / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy; D009460:Neurologic Examination; D010243:Paralysis / Q000209:etiology / Q000628:therapy; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D015607:Stents
chemical_list: D000641:Ammonia