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Clinical outcomes related to portal pressures before and after embolization of large portosystemic shunts in cirrhosis

OBJECTIVES: Embolization of large portosystemic shunts effectively controls gastric variceal bleeding and prevents hepatic encephalopathy. The significance of dynamic changes in hepatic venous pressure gradient before and after embolization on clinical events and patient outcomes remains unknown. ME...

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Autores principales: Rajesh, Sasidharan, Philips, Cyriac Abby, Ahamed, Rizwan, Singh, Shobhit, Abduljaleel, Jinsha K, Tharakan, Ajit, Augustine, Philip
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10617273/
https://www.ncbi.nlm.nih.gov/pubmed/37915841
http://dx.doi.org/10.1177/20503121231208655
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author Rajesh, Sasidharan
Philips, Cyriac Abby
Ahamed, Rizwan
Singh, Shobhit
Abduljaleel, Jinsha K
Tharakan, Ajit
Augustine, Philip
author_facet Rajesh, Sasidharan
Philips, Cyriac Abby
Ahamed, Rizwan
Singh, Shobhit
Abduljaleel, Jinsha K
Tharakan, Ajit
Augustine, Philip
author_sort Rajesh, Sasidharan
collection PubMed
description OBJECTIVES: Embolization of large portosystemic shunts effectively controls gastric variceal bleeding and prevents hepatic encephalopathy. The significance of dynamic changes in hepatic venous pressure gradient before and after embolization on clinical events and patient outcomes remains unknown. METHODS: In this retrospective single-center series, 46 patients with gastric variceal bleeding, hepatic encephalopathy, or both undergoing embolization (January 2018 to October 2020) were included, and dynamic changes in portal pressures were analyzed against patient outcomes. RESULTS: Males predominated. The most common portosystemic shunt syndrome was the lienorenal shunt. In all, 34 patients underwent embolization for hepatic encephalopathy and 11 for gastric variceal bleeding. The proportion of patients surviving at the end of 12 and 32 months was 86.96 and 54.35%, respectively. The hepatic venous pressure gradient before shunt embolization was 13.4 ± 3.2 and 16.9 ± 3.7 mm Hg after occlusion (p < 0.001). Bleeding from varices on overall follow-up was notable in five patients (10.9%), and overt hepatic encephalopathy in four (N = 42, 9.5%) patients at 6–12 months. The development of infections within 100 days and beyond the first year was associated with the risk of dying at the end of 12 and 32 months, respectively. Elevation of hepatic venous pressure gradient by >4 mm Hg from baseline and an absolute increase to >16 mm Hg immediately post-procedure significantly predicted the development of early- and late-onset ascites, respectively. CONCLUSION: Close monitoring for the development of infections and optimization of beta-blockers and diuretics after shunt embolization may improve clinical outcomes and help identify patients who will benefit from liver transplantation pending prospective validation.
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spelling pubmed-106172732023-11-01 Clinical outcomes related to portal pressures before and after embolization of large portosystemic shunts in cirrhosis Rajesh, Sasidharan Philips, Cyriac Abby Ahamed, Rizwan Singh, Shobhit Abduljaleel, Jinsha K Tharakan, Ajit Augustine, Philip SAGE Open Med Original Article OBJECTIVES: Embolization of large portosystemic shunts effectively controls gastric variceal bleeding and prevents hepatic encephalopathy. The significance of dynamic changes in hepatic venous pressure gradient before and after embolization on clinical events and patient outcomes remains unknown. METHODS: In this retrospective single-center series, 46 patients with gastric variceal bleeding, hepatic encephalopathy, or both undergoing embolization (January 2018 to October 2020) were included, and dynamic changes in portal pressures were analyzed against patient outcomes. RESULTS: Males predominated. The most common portosystemic shunt syndrome was the lienorenal shunt. In all, 34 patients underwent embolization for hepatic encephalopathy and 11 for gastric variceal bleeding. The proportion of patients surviving at the end of 12 and 32 months was 86.96 and 54.35%, respectively. The hepatic venous pressure gradient before shunt embolization was 13.4 ± 3.2 and 16.9 ± 3.7 mm Hg after occlusion (p < 0.001). Bleeding from varices on overall follow-up was notable in five patients (10.9%), and overt hepatic encephalopathy in four (N = 42, 9.5%) patients at 6–12 months. The development of infections within 100 days and beyond the first year was associated with the risk of dying at the end of 12 and 32 months, respectively. Elevation of hepatic venous pressure gradient by >4 mm Hg from baseline and an absolute increase to >16 mm Hg immediately post-procedure significantly predicted the development of early- and late-onset ascites, respectively. CONCLUSION: Close monitoring for the development of infections and optimization of beta-blockers and diuretics after shunt embolization may improve clinical outcomes and help identify patients who will benefit from liver transplantation pending prospective validation. SAGE Publications 2023-10-29 /pmc/articles/PMC10617273/ /pubmed/37915841 http://dx.doi.org/10.1177/20503121231208655 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Article
Rajesh, Sasidharan
Philips, Cyriac Abby
Ahamed, Rizwan
Singh, Shobhit
Abduljaleel, Jinsha K
Tharakan, Ajit
Augustine, Philip
Clinical outcomes related to portal pressures before and after embolization of large portosystemic shunts in cirrhosis
title Clinical outcomes related to portal pressures before and after embolization of large portosystemic shunts in cirrhosis
title_full Clinical outcomes related to portal pressures before and after embolization of large portosystemic shunts in cirrhosis
title_fullStr Clinical outcomes related to portal pressures before and after embolization of large portosystemic shunts in cirrhosis
title_full_unstemmed Clinical outcomes related to portal pressures before and after embolization of large portosystemic shunts in cirrhosis
title_short Clinical outcomes related to portal pressures before and after embolization of large portosystemic shunts in cirrhosis
title_sort clinical outcomes related to portal pressures before and after embolization of large portosystemic shunts in cirrhosis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10617273/
https://www.ncbi.nlm.nih.gov/pubmed/37915841
http://dx.doi.org/10.1177/20503121231208655
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