Large Paraumbilical Vein Shunts Increase the Risk of Overt Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Placement

Background: This study aimed to evaluate whether a large paraumbilical vein (L-PUV) was independently associated with the occurrence of overt hepatic encephalopathy (OHE) after the implantation of a transjugular intrahepatic portosystemic shunt (TIPS). Methods: This bi-center retrospective study included patients with cirrhotic variceal bleeding treated with a TIPS between December 2015 and June 2021. An L-PUV was defined in line with the following criteria: cross-sectional areas < 83 square millimeters, diameter ≥ 8 mm, or greater than half of the diameter of the main portal vein. The primary outcome was the 2-year OHE rate, and secondary outcomes included the 2-year mortality, all-cause rebleeding rate, and shunt dysfunction rate. Results: After 1:2 propensity score matching, a total of 27 patients with an L-PUV and 54 patients without any SPSS (control group) were included. Patients with an L-PUV had significantly higher 2-year OHE rates compared with the control group (51.9% vs. 25.9%, HR = 2.301, 95%CI 1.094–4.839, <i<p</i< = 0.028) and similar rates of 2-year mortality (14.8% vs. 11.1%, HR = 1.497, 95%CI 0.422–5.314, <i<p</i< = 0.532), as well as variceal rebleeding (11.1% vs. 13.0%, HR = 0.860, 95%CI 0.222–3.327, <i<p</i< = 0.827). Liver function parameters were similar in both groups during the follow-up, with a tendency toward higher shunt patency in the L-PUV group (<i<p</i< = 0.067). Multivariate analysis indicated that having an L-PUV (HR = 2.127, 95%CI 1.050–4.682, <i<p</i< = 0.037) was the only independent risk factor for the incidence of 2-year OHE. Conclusions: Having an L-PUV was associated with an increased risk of OHE after a TIPS. Prophylaxis management should be considered during clinical management..

Medienart:	E-Artikel

Erscheinungsjahr:	2022
Erschienen:	2022

Enthalten in:	Zur Gesamtaufnahme - volume:12
Enthalten in:	Journal of Clinical Medicine - 12(2022), 1, p 158

Sprache:	Englisch

Beteiligte Personen:	Hao-Huan Tang [VerfasserIn] Zi-Chen Zhang [VerfasserIn] Zi-Le Zhao [VerfasserIn] Bin-Yan Zhong [VerfasserIn] Chen Fan [VerfasserIn] Xiao-Li Zhu [VerfasserIn] Wei-Dong Wang [VerfasserIn]

Links:	doi.org [kostenfrei] doaj.org [kostenfrei] www.mdpi.com [kostenfrei] Journal toc [kostenfrei]

Themen:	Hepatic encephalopathy Medicine Paraumbilical vein R Spontaneous portal shunts Transjugular intrahepatic portosystemic shunt

doi:	10.3390/jcm12010158

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	DOAJ082606919