title: Percutaneous shunt reduction for the management of TIPS-induced acute liver decompensation: A follow-up study.
abstract: Background and rationale for the study. The purpose of this study was to assess the technical and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) reduction for the management of TIPS-induced acute liver decompensation. Between August 2000 and November 2013, 347 patients underwent a TIPS procedure in the authors' institution; 21/347 (6%) developed post-TIPS acute liver decompensation which was managed using a percutaneous shunt reduction technique. Patient demographics, laboratory tests before and after initial TIPS and TIPS reduction, procedural data and clinical follow-up data were analysed.
  
  
  RESULTS
  Twenty-one patients (mean age 63 years) who underwent an initial TIPS procedure for variceal bleeding (n = 7; 33%) or refractory ascites (n = 14; 67%) successfully underwent shunt reduction ten days (3-34 days) after the initial TIPS procedure. The portosystemic pressure gradient (PSPG) increased from 8 (3-17) mmHg before reduction to 12 (7-23) mmHg after shunt reduction. Survival at one and six months follow-up was 15 (71%) and 11 patients (52%), respectively. The international normalised ratio (INR) (1.7 vs. 1.5; p = 0.044) was significantly different after TIPS reduction in the non-survival group compared to the survival group. In conclusion, TIPS reduction for the management of TIPS-induced acute liver decompensation is technically feasible and is associated with a one and six-month mortality rate of 29% and 48%, respectively. Higher post-TIPS-reduction INR values may be associated with higher risk of early mortality.
authors.affiliation: Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology, KU Leuven, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: De Keyzer
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium.
authors.forename: Frederik
authors.initials: F
authors.lastname: Nevens
authors.affiliation: Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Catholic University of Leuven and Hasselt University, Belgium.
authors.forename: Annouschka
authors.initials: A
authors.lastname: Laenen
authors.affiliation: Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology, KU Leuven, Belgium.
authors.forename: Sam
authors.initials: S
authors.lastname: Heye
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Laleman
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium.
authors.forename: Chris
authors.initials: C
authors.lastname: Verslype
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospitals Leuven, Belgium.
authors.forename: Schalk
authors.initials: S
authors.lastname: van der Merwe
authors.affiliation: Department of Radiology, University Hospitals Leuven, Department of Imaging & Pathology, KU Leuven, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Maleux
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D001530:Belgium; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects* / Q000401:mortality; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome