title: Comparison of Vascular Plugs and Pushable Coils for Variceal Embolization After TIPS.
abstract: OBJECTIVE
  Transjugular intrahepatic portosystemic shunt (TIPS) with variceal embolization is routinely performed to treat variceal bleeding. Embolization using vascular plugs is reported, but outcomes are not known. Outcomes and material costs of embolization using vascular plugs and coils are compared.
  
  
  METHODS
  A single center's medical records of TIPS procedures (May 2003-December 2014) with variceal embolization were reviewed. Twenty patients with vascular plug embolization (age [± SD], 50 ± 10 years; seven men and 13 women; median Model for End-Stage Liver Disease [MELD], 20; interquartile range [IQR], 14-23) were compared with an age-, sex-, and MELD-matched cohort who underwent coil embolization (age, 50 ± 9 years; seven men and 13 women; median MELD, 17; IQR, 15-19; p = 0.52). Procedure details, primary outcome (rebleeding), secondary outcome (mortality), and costs were compared.
  
  
  RESULTS
  Vascular plug use was associated with a lower fluoroscopy time (49.05 minutes [IQR, 36-62] vs 68 minutes [IQR, 49-76]; p = 0.006) and total procedure time (255 minutes [IQR, 205-290] for vascular plugs vs 275 minutes [IQR, 230-330]; p = 0.05). Total volume of contrast agent used was similar (180 mL [IQR, 155-234] for vascular plugs vs 210 mL [IQR, 185-261]; p = 0.14). In patients with at least a 30-day follow-up, rebleeding rates (2/17 [12%] for vascular plugs vs 4/15 [27%]; p = 0.40) and mortality (2/17 [12%] for vascular plugs vs 4/15 [27%]; p = 0.66) were similar. Per procedure, vascular plugs cost significantly more than coils ($1292 ± $676 vs $228 ± $292, p < 0.0001).
  
  
  CONCLUSIONS
  The use of vascular plugs or coils has similar outcomes for variceal embolization after TIPS. The advantages of vascular plug use (i.e., reduced fluoroscopy or procedure time) may be offset by increased material cost, a trade-off that merits further study given current cost concerns in health care.
authors.affiliation: 1 Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Deaconess Rd, WCC-3, Boston, MA 02215.
authors.forename: Ammar
authors.initials: A
authors.lastname: Sarwar
authors.affiliation: 1 Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Deaconess Rd, WCC-3, Boston, MA 02215.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Esparaz
authors.affiliation: 2 Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors.forename: Elliot B
authors.initials: EB
authors.lastname: Tapper
authors.affiliation: 1 Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Deaconess Rd, WCC-3, Boston, MA 02215.
authors.forename: Olga R
authors.initials: OR
authors.lastname: Brook
authors.affiliation: 2 Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Grunwald
authors.affiliation: 2 Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors.forename: Raza
authors.initials: R
authors.lastname: Malik
authors.affiliation: 1 Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Deaconess Rd, WCC-3, Boston, MA 02215.
authors.forename: Muneeb
authors.initials: M
authors.lastname: Ahmed
mesh_terms: D003131:Combined Modality Therapy / Q000379:methods; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014648:Varicose Veins
keywords: Amplatzer Vascular Plug; coil embolization; embolization; transjugular intrahepatic portosystemic shunt (TIPS); variceal bleeding