Transjugular intrahepatic portosystemic stent-shunt as minimally invasive method of portal hypertension correction in multi-disciplinary clinic
V. M. Durleshter,
S. A. Gabriel’,
N. V. Korochanskaya,
A. Yu. Buhtoyarov,
P. V. Markov,
D. S. Murashko,
O. A. Oganesyan,
L. G. Izmailova,
M. A. Basenko,
Yu. V. Horon'ko https://doi.org/10.16931/1995-5464.2020495-106
Abstract
Aim. Optimization of the tactics of management of patients with liver cirrhosis who underwent Transjugular Intrahepatic Portosystemic Shunt – TIPS based on own experience and literature data.
Materials and methods. From 2014 to 2019 years 51 Transjugular Intrahepatic Portosystemic Shunt procedures were performed.
Results. The indications for Transjugular Intrahepatic Portosystemic Shunt procedure were detailed. The tactics of treatment in post-operative period was assessed. Shot-term and long-term results of the treatment were discussed. Especial attention was put to persons who included in patient list of liver transplantation.
Conclusion. Transjugular Intrahepatic Portosystemic Shunt allows obtaining stable decompression in portal system that reduces frequency of bleeding relapse from gastric and esophageal veins. The mortality was decreased, and patients can wait till liver transplantation.
About the Authors
V. M. Durleshter
Kuban State Medical University, Department of Surgery No.3, Faculty of Advanced Training and Professional Retraining of Specialists, Russia;
Region Clinic Hospital No.2, Ministry of Health of the Krasnodar Region, Russia
Russian Federation
Russian Federation
Vladimir M. Durleshter – Doct. of Sci. (Med.), Professor, Head of the Department of Surgery No.3;
Kuban State Medical University, Deputy Chief Physician for Surgery of the Region Clinic Hospital No.2
4, Sedina str., Krasnodar, 4350063;
6/2, Krasnikh Partisan str., Krasnodar, 350012
S. A. Gabriel’
Kuban State Medical University, Department of Surgery No.3, Faculty of Advanced Training and Professional Retraining of Specialists, Russia;
Region Clinic Hospital No.2, Ministry of Health of the Krasnodar Region, Russia
Russian Federation
Russian Federation
Sergey A. Gabriel’ – Doct. of Sci. (Med.), Professor, Chief Physician of the Region Clinic Hospital No.2;
Professor of the Department of Surgery No.3, Kuban State Medical University
4, Sedina str., Krasnodar, 4350063;
6/2, Krasnikh Partisan str., Krasnodar, 350012
N. V. Korochanskaya
Kuban State Medical University, Department of Surgery No.3, Faculty of Advanced Training and Professional Retraining of Specialists, Russia;
Region Clinic Hospital No.2, Ministry of Health of the Krasnodar Region, Russia
Russian Federation
Russian Federation
Nataliya V. Korochanskaya – Doct. of Sci. (Med.), Head of the Gastroenterology Centre of the Region Clinic Hospital No.2;
Professor of the Department of Surgery No.3, Kuban State Medical University
4, Sedina str., Krasnodar, 4350063;
6/2, Krasnikh Partisan str., Krasnodar, 350012, Phone: +7-918-467-53-24
A. Yu. Buhtoyarov
Region Clinic Hospital No.2, Ministry of Health of the Krasnodar Region, Russia
Russian Federation
Russian Federation
Artem Yu. Buhtoyarov – Head of the Department of Interventional Radiology No.2
6/2, Krasnikh Partisan str., Krasnodar, 350012
P. V. Markov
Kuban State Medical University, Department of Surgery No.3, Faculty of Advanced Training and Professional Retraining of Specialists, Russia;
Region Clinic Hospital No.2, Ministry of Health of the Krasnodar Region, Russia
Russian Federation
Russian Federation
Pavel V. Markov – Doct. of Sci. (Med.), Head of the Surgical Department No.5 of the Region Clinic Hospital No.2;
Professor of the Department of Surgery No.3, Kuban State Medical University
4, Sedina str., Krasnodar, 4350063;
6/2, Krasnikh Partisan str., Krasnodar, 350012
D. S. Murashko
Kuban State Medical University, Department of Surgery No.3, Faculty of Advanced Training and Professional Retraining of Specialists, Russia;
Region Clinic Hospital No.2, Ministry of Health of the Krasnodar Region, Russia
Russian Federation
Russian Federation
Dmitriy S. Murashko – Doct. of Sci. (Med.), Surgeon of Surgical Department No.5 of the Region Clinic Hospital No.2;
Assistant of the Department of Surgery No.3, Kuban State Medical University
4, Sedina str., Krasnodar, 4350063;
6/2, Krasnikh Partisan str., Krasnodar, 350012
O. A. Oganesyan
Region Clinic Hospital No.2, Ministry of Health of the Krasnodar Region, Russia
Russian Federation
Russian Federation
Oganes A. Oganesyan – Physician of the Department of Interventional Radiology No.2
6/2, Krasnikh Partisan str., Krasnodar, 350012
L. G. Izmailova
Region Clinic Hospital No.2, Ministry of Health of the Krasnodar Region, Russia
Russian Federation
Russian Federation
Laura G. Izmailova – Doct. of Sci. (Med.), Specialists of Ultrasound Diagnostics of the Department of Interventional Radiology No.1
6/2, Krasnikh Partisan str., Krasnodar, 350012
M. A. Basenko
Kuban State Medical University, Department of Surgery No.3, Faculty of Advanced Training and Professional Retraining of Specialists, Russia
Russian Federation
Russian Federation
Mikhail A. Basenko – Resident of the Department of Surgery No.3
4, Sedina str., Krasnodar, 4350063
Yu. V. Horon'ko
Rostov State Medical University, Rostov-on-Don Region, Russia
Russian Federation
Russian Federation
Yuriy V. Khoron'ko – Doct. of Sci. (Med.), Professor, Head of the Department of Operative Surgery and Topographic Anatomy, Surgeon
29, Nakhichevansky Lane, Rostov-on-Don, 344022
References
1. Tripathi D., Stanley A.J., Hayes P.C., Travis S., Armstrong M., Tsochatzis E., Rowe I., Roslund N., Ireland H., Lomax M., Leithead J., Mehrzad H., Aspinall R., McDonagh J., Patch D. Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension. Gut. 2020; 0: 1–20. https://doi.org/10.1136/gutjnl-2019-320221.
2. Anisimov A.Yu., Vertkin A.L., Devyatov A.V., Dzidzava I.I., Jigalova S.B., Zatevakhin I.I., Ivashkin V.T., Kitcenko E.A., Kotiv B.N., Lebezev V.M., Lopatkina T.N., Maevskaya M.V., Manuk’yan G.V., Monakhov D.V., Nazyirov F.G., Ogurtsov P.P., Pavlov Ch.S., Prudkov M.I., Khoron’ko Yu.V., Tsitsiashvili M. Sh., Chjao A.V., Shertsinger A.G., Shipovskiy V.N. Klinicheskie rekomendacii po lecheniyu krovotechenij iz varikozno rasshirennyh ven pishchevoda i zheludka [Clinic guidelines for the treatment of bleeding from esophageal and gastric varicose veins] (Adopted at the All-Russian consensus conference on the adoption of the National clinic recommendations on the topic of “Bleeding from the upper gastrointestinal tract”, Voronej, 5–6 June 2014. Russian Society of Surgeons, Hepato-PancreatoBiliary Association of Commonwealth of Independent States). Moscow – Voronej, 2014. 46 p. (In Russian)
3. Khoronko Y.V., Dudarev S.I., Glebov K.A. Adapting portal decompression for elevation of efficacy of portosystemic shunting operations in portal hypertension. Medical Herald of the South of Russia. 2016; 3:100–105. (In Russian) https://doi.org/10.21886/2219-8075-2016-3-100-103.
4. Kitcenko E.A., Anisimov A.Yu., Andreev A.I. The modern state of bleeding from variceal enlarged veins of esophagus and stomach. Vestnik Sovremennoi Klinicheskoi Mediciny [The Bulletin of Contemporary Clinical Medicine]. 2014; 7 (5): 89–98. (In Russian)
5. Kotiv B.N., Dzidzava I.I., Soldatov S.A., Кashkin D.P., Alentiev S.A., Smorodskiy A.V., Slobodyanik A.V., Оnincev I.E. Results of the selective and partial portocaval bypass and prognostic factors of long-term survival in patients with liver cirrhosis. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2015; 20 (2): 46–58. (In Russian) https://doi.org/10.16931/1995-5464.2015246-58.
6. Manukyan G.V., Shertsinger A.G. Differentiated surgical treatment of portal hypertension and its complications in patients with liver cirrhosis. Part I. Assessment of diseases severity and choice of surgical intervention. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2015; 20 (1): 14–23. https://doi.org/10.16931/1995-5464.2015114-23 (In Russian)
7. Manuk'yan G.V., Musin R.A., Manuk'yan V.G. Differentiated surgical treatment of patients with liver cirrhosis and portal hypertension. Part II. Surgical aggression and pathogenesis of postoperative complications. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2015; 20 (2): 8–19. https://doi.org/10.16931/1995-5464.201528-19 (In Russian)
8. Durleshter V.M., Buhtoyarov A.Yu., Chehoev S.V., Lyaskovskiy K.O., Nikitin S.P. The use of coronary techniques in transjugular intrahepatic portosystemic shunting operations. Nauchnyj vestnik zdravoohraneniya Kubani. 2016; 48 (6): 36–43. (In Russian)
9. Ivashkin V.T., Mayevskaya M.V., Pavlov C.S., Fedosyina Y.A., Bessonova Y.N., Pirogova I.Yu., Garbuzenko D.V. Treatment of liver cirrhosis complications: Clinical guidelines of the Russian Scientific Liver Society and Russian Gastroenterological Association. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2016; 26 (4): 71–102. https://doi.org/10.22416/1382-4376-2016-26-4-71-102 (In Russian)
10. de Franchis R., on behalf of the Baveno VI Faculty. Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J. Hepatol. 2015; 63 (3): 743–752. https://doi.org/10.1016/j.jhep.2015.05.022.
11. The European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J. Hepatol. 2018; 69 (2): 406–460. https://doi.org/10.1016/j.jhep.2018.03.024.
12. Azoulay D., Castaing D., Majno P., Saliba F., Ichaï P., Smail A., Delvart D., Danaoui M., Samuel D., Bismuthet H. Salvage transjugular intrahepatic portosystemic shunt for uncontrolled variceal bleeding in patients with decompensated cirrhosis. J. Hepatol. 2001; 35 (5): 590–597. https://doi.org/10.21037/amj.2017.10.07.
13. Maimone S., Saffioti F., Filomia R., Alibrandi A., Isgrò G., Calvaruso V., Xirouchakis E., Guerrini G., Burroughs A., Tsochatzis E., Patch D. Predictors of re-bleeding and mortality among patients with refractory variceal bleeding undergoing salvage transjugular intrahepatic portosystemic shunt (TIPS). Dig. Dis. Sci. 2019; 64 (5): 1335–1345. http://dx.doi.org/10.1007/s10620-018-5412-x.
14. Zhang H., Zhang H., Li H., Zhang H., Zheng D., Sun C., Wu J. TIPS versus endoscopic therapy for variceal rebleeding in cirrhosis: a meta-analysis update. J. Huazhong Univ. Sci. Technolog. Med. Sci. 2017; 37 (2): 475–485. https://doi.org/10.1007/s11596-017-1760-6.
15. Lv Y., Qi X., He C., Wang Z., Yin Z., Niu J., Guo W., Bai W., Zhang H., Xie H., Yao L., Wang J., Li J., Li T., Wang Q., Liu H., Wang Q., Liu H., Wang E., Xia D., Luo B., Li X., Yuan J., Han N., Zhu Y., Xia Y., Cai H., Yang Z., Wu K., Fan D., Han G. Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial. Gut. 2018; 67 (12): 2156–2168. https://doi.org/10.1136/gutjnl-2017-314634.
16. Narahara Y., Kanazawa H., Fukuda T., Matsushita Y., Harimoto H., Kidokoro H., Katakura I., Atsukawa M., Taki G., Kimura G., Nakatsuka K., Sakamoto C. Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function: a prospective randomized trial. J. Gastroenterol. 2011; 46 (1): 78–85. https://doi.org/10.1007/s00535-010-0282-9.
17. Bureau C., Thabut D., Oberti F., Dharancy S., Carbonell N., Bouvier A., Mathurin P., Otal P., Cabarrou P., Péron J., Vinel J. Transjugular intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites. Gastroenterology. 2017; 152 (1): 157–163. https://doi.org/10.1007/s11901-019-00470-4.
18. Bai M., Qi X., Yang Z., Yang M., Fan D., Han G. TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites: an updated meta-analysis. WJG. 2014; 20 (10): 2704–2714. https://doi.org/10.3748/wjg.v20.i10.2704.
19. Chen R.P., Zhu Ge X.J., Huang Z.M., Ye X., Hu C., Lu Y., Lu D., Phemba I. Prophylactic use of transjugular intrahepatic portosystemic shunt AIDS in the treatment of refractory ascites: metaregression and trial sequential meta-analysis. J. Clin. Gastroenterol. 2014; 48 (3): 290–299. https://doi.org/10.1097/MCG.0b013e3182a115e9.
20. Russle M., Schultheiss M. Commentary on “Covered TIPS for secondary prophylaxis of variceal bleeding in liver cirrhosis: a systematic review and meta-analysis of randomized controlled trials”. AME Med. J. 2017; 10 (2): 33. https://doi.org/10.21037/amj.2017.03.02.
21. Dunne P., Sinha R., Stanley A., Lachlan N., Ireland H., Shams A., Hayes P. OTU-09 use of early-TIPSS in patients with oesophageal variceal bleeding, a UK dual-centre randomised control trial. Gut. 2019; 68 (Suppl 2): A106–107.
22. Vilstrup H., Amodio P., Bajaj J., Cordoba J., Ferenci P., Mullen K., Weissenborn K., Wong P. Hepatic Encephalopathy in Chronic Liver Disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. J. Hepatol. 2014; 60 (2): 642–659. http://dx.doi.org/10.1016/j.jhep.2014.05.042.
23. Masson S., Mardini H.A., Rose J.D., Record C.O. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt insertion: a decade of experience. Quarterly J. Med. 2008; 101 (6): 493–501. https://doi.org/10.1093/qjmed/hcn037.
24. Campbell M.S., Brensinger C.M., Sanyal A.J., Gennings C., Wong F., Kowdley K.V., Mccashland T., Reddy K. Quality of life in refractory ascites: transjugular intrahepatic portalsystemic shunting versus medical therapy. Hepatology. 2005; 42 (3): 635–640. http://dx.doi.org/10.1002/hep.20840.
25. Stewart C.A., Malinchoc M., Kim W.R., Kamath P.S. Hepatic encephalopathy as a predictor of survival in patients with endstage liver disease. Liver Transpl. 2007; 13 (10): 1366–1371. https://doi.org/10.1002/lt.21129.
26. Stefánková J., Hulek P., Babu A., Cermáková E., Safka V., Stefanek J., Fejfar T., Krajina A. Hepatic encephalopathy due to TIPS-retrospective study. Hepatogastroenterology. 2007; 54 (74): 480–484.
27. Somberg K.A., Riegler J.L., Laberge J.M., Doherty-Simor M.M., Bachetti P., Roberts J.P., Lake J.R. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunts: incidence and risk factors. Am. J. Gastroenterol. 1995; 90 (4): 549–555. https://doi.org/10.16931/1995-5464.2015240-45.
28. Rössle M., Deibert P., Haag K., Ochs A., Olschewski M., Siegerstetter V., Hauenstein K. Randomised trial of transjugular-intrahepatic-portosystemic shunt versus endoscopy plus propranolol for prevention of variceal rebleeding. Lancet. 1997; 349 (9058): 1043–1049. https://doi.org/10.3748/wjg.v19.i37.6131.
29. Mamiya Y., Kanazawa H., Kimura Y., Narahara Y., Yamate Y., Nakatsuka K., Sakamoto C. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Hepatol. Res. 2004; 30 (1): 162–168. https://doi.org/10.1016/j.hepres.2004.09.003.
30. Bahn E., Nolte W., Kurth C., Ramadori G., Rüther E., Wiltfang J. Quantification of the electroencephalographic theta/alpha ratio for the assessment of portal-systemic encephalopathy following implantation of transjugular intrahepatic portosystemic stent shunt (TIPSS). Metab. Brain Dis. 2002; 17 (1): 19–28. https://doi.org/10.1023/a:1014048229754.
31. ter Borg P.C., Hollemans M., Van Buuren H.R., Vleggaar F.P., Groeneweg M., Hop W.C., Laméris J.S. Transjugular intrahepatic portosystemic shunts: long-term patency and clinical results in a patient cohort observed for 3–9 years. Radiology. 2004; 231 (3): 537–545.
32. Leite N.C., Villela-Nogueira C.A., Cardoso C.R.L., Salles G.F. Nonalcoholic fatty liver disease and diabetes: from physiopathological interplay to diagnosis and treatment. World J. Gastroenterol. 2014; 20 (26): 8377–8392. https://doi.org/10.3748/wjg.v20.i26.8377.
33. Stockwell T., Zhao J., Greenfield T., Li J., Livingston M., Meng Y. Estimating under- and over-reporting of drinking in national surveys of alcohol consumption: identification of consistent biases across four English-speaking countries. Addiction. 2016; 111 (7): 1203–1213. http://doi.org/10.1111/add.13373.
34. Dell’Era A., Grande L., Barros-Schelotto P., Turnes J., Fuster J., Charco R., García-Valdecasas J.C., Bosch J., García-Pagán J.C. Impact of prior portosystemic shunt procedures on outcome of liver transplantation. Surgery. 2005; 137 (6): 620–625. https://doi.org/10.1016/j.surg.2005.02.004.
35. Casadaban L.C., Gabra M.G., Parvinian A., Minocha J., Gaba R. Impact of transjugular intrahepatic portosystemic shunt creation on intermediate-term model for end-stage liver disease score progression. Transplant. Proc. 2014; 46 (6): 1384–1388. https://doi.org/10.1016/j.transproceed.2013.12.053.
36. Feyssa E., Ortiz J., Grewal K., Azhar A., Parsikia A., Tufail K., Hashemi N., Brady P., Araya V. MELD score less than 15 predicts prolonged survival after transjugular intrahepatic portosystemic shunt for refractory ascites after liver transplantation. Transplantation. 2011; 91 (7): 786–792. https://doi.org/10.1097/TP.0b013e31820e014e.
37. Tripathi D., Therapondos G., Redhead D.N., Hayes P.C. Transjugular intrahepatic portosystemic stent-shunt and its effects on orthotopic liver transplantation. Eur. J. Gastroenterol. Hepatol. 2002; 14 (7): 827–832. https://doi.org/10.1097/00042737-200208000-00003.
38. Dell’Era A., Grande L., Barros-Schelotto P., Turnes J., Fuster J., Charco R., García-Valdecasas J.C., Bosch J., García-Pagán J.C. Impact of prior portosystemic shunt procedures on outcome of liver transplantation. Surgery. 2005; 137 (6): 620–625. https://doi.org/10.1016/j.surg.2005.02.004.
39. Salem R., Vouche M., Baker T., Herrero J., Caicedo J., Fryer J., Hickey R., Habib A., Abecassis M., Koller F., Vogelzang R., Desai K., Thornburg B., Hohlastos E., Resnick S., Lewandowski R., Sato K., Ryu R., Ganger D., Kulik L. Pretransplant portal vein recanalization-transjugular intrahepatic portosystemic shunt in patients with complete obliterative portal vein thrombosis. Transplantation. 2015; 99 (11): 2347–2355. https://doi.org/10.1097/TP.0000000000000729.
40. Guerrini G.P., Pleguezuelo M., Maimone S., Calvaruso V., Xirouchakis E., Patch D., Rolando N., Davidson B., Rolles K., Burroughset A. Impact of TIPS prelivertransplantation for the outcome posttransplantation. Am. J. Transplant. 2009; 9 (1): 192–200. https://doi.org/10.1111/j.1600-6143.2008.02472.x.
41. Barbier L., Hardwigsen J., Borentain P. Impact of transjugular intrahepatic portosystemic shunting on liver transplantation: 12-year single-center experience. Clin. Res. Hepatol. Gastroenterol. 2014; 38 (1): 155–163. https://doi.org/10.1016/j.clinre.2013.09.003.
42. Saad W.E.A., Darcy M.D. Transjugular intrahepatic portosystemic shunt (TIPS) versus balloon-occluded retrograde transvenous obliteration (BRTO) for the management of gastric varices. Seminars Intervent. Radiol. 2011; 28 (3): 339–349. https://doi.org/10.1055/s-0031-1284461.
Review
For citations:
Durleshter V.M., Gabriel’ S.A., Korochanskaya N.V., Buhtoyarov A.Yu., Markov P.V., Murashko D.S., Oganesyan O.A., Izmailova L.G., Basenko M.A., Horon'ko Yu.V. Transjugular intrahepatic portosystemic stent-shunt as minimally invasive method of portal hypertension correction in multi-disciplinary clinic. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2020;25(4):95-106. (In Russ.) https://doi.org/10.16931/1995-5464.2020495-106
Views:
1486
Email this article 