title: The presence of spontaneous portosystemic shunts increases the risk of complications after transjugular intrahepatic portosystemic shunt (TIPS) placement.
abstract: OBJECTIVE
  The goal of this study was to identify clinical and imaging variables that are associated with an unfavorable outcome during the 30 days following transjugular intrahepatic portosystemic shunt (TIPS) placement.
  
  
  METHODS
  Fifty-four consecutive patients with liver cirrhosis (Child-Pugh 6-13, Model for End-stage Liver Disease 7-26) underwent TIPS placement for refractory ascites (n=25), recurrent or uncontrolled variceal bleeding (n=23) or both (n=6). Clinical, biological and imaging variables including type of stent (covered n=40; bare-stent n=14), presence of spontaneous portosystemic shunt (n=31), and variations in portosystemic pressure gradient were recorded. Early severe complication was defined as the occurrence of overt hepatic encephalopathy or death within the 30days following TIPS placement.
  
  
  RESULTS
  Sixteen patients (30%) presented with early severe complication after TIPS placement. Child-Pugh score was independently associated with complication (HR=1.52, P<0.001). Among the imaging variables, opacification of spontaneous portosystemic shunt during TIPS placement but before its creation was associated with an increased risk of early complication (P=0.04). The other imaging variables were not associated with occurrence of complication.
  
  
  CONCLUSIONS
  Identification of spontaneous portosystemic shunt during TIPS placement reflects the presence of varices and is associated with an increased risk of early severe complication.
authors.affiliation: Service d'hépato-gastro-entérologie, centre hospitalier universitaire Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France; UMR 911, université de la Méditerranée, 27, boulevard Jean-Moulin, 13005 Marseille, France. Electronic address: patrick.borentain@ap-hm.fr.
authors.forename: P
authors.initials: P
authors.lastname: Borentain
authors.affiliation: Service de radiologie, centre hospitalier universitaire Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
authors.forename: J
authors.initials: J
authors.lastname: Soussan
authors.affiliation: Aix-Marseille université, UMRS 912 (SESSTIM), IRD, 13385 Marseille, France; Service de santé publique et d'information médicale, centre hospitalier universitaire Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
authors.forename: N
authors.initials: N
authors.lastname: Resseguier
authors.affiliation: Service d'hépato-gastro-entérologie, centre hospitalier universitaire Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
authors.forename: D
authors.initials: D
authors.lastname: Botta-Fridlund
authors.affiliation: Aix-Marseille université, UMRS 912 (SESSTIM), IRD, 13385 Marseille, France; Service de santé publique et d'information médicale, centre hospitalier universitaire Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Dufour
authors.affiliation: Service d'hépato-gastro-entérologie, centre hospitalier universitaire Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France; UMR 911, université de la Méditerranée, 27, boulevard Jean-Moulin, 13005 Marseille, France.
authors.forename: R
authors.initials: R
authors.lastname: Gérolami
authors.affiliation: Service de radiologie, centre hospitalier universitaire Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
authors.forename: V
authors.initials: V
authors.lastname: Vidal
mesh_terms: D001201:Ascites / Q000209:etiology / Q000628:therapy; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy; D006501:Hepatic Encephalopathy / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000002:abnormalities*; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications
keywords: Hepatic encephalopathy; Portal hypertension; Spontaneous portosystemic shunt; Transjugular intrahepatic portosystemic shunt