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Portal flow diversion based on portography is superior than puncture site in the prediction of overt hepatic encephalopathy after TIPS creation

BACKGROUND: Targeted puncture of an appropriate portal venous branch during transjugular intrahepatic portosystemic shunt (TIPS) procedure may reduce the risk of postprocedural overt hepatic encephalopathy (HE). This study aimed to describe blood distribution under portography and combined it with p...

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Autores principales: Yang, Chongtu, Chen, Yang, Wang, Chaoyang, Liu, Jiacheng, Huang, Songjiang, Zhou, Chen, Wang, Yingliang, Ju, Shuguang, Li, Tongqiang, Bai, Yaowei, Yao, Wei, Xiong, Bin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9336111/
https://www.ncbi.nlm.nih.gov/pubmed/35906529
http://dx.doi.org/10.1186/s12876-022-02447-y
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author Yang, Chongtu
Chen, Yang
Wang, Chaoyang
Liu, Jiacheng
Huang, Songjiang
Zhou, Chen
Wang, Yingliang
Ju, Shuguang
Li, Tongqiang
Bai, Yaowei
Yao, Wei
Xiong, Bin
author_facet Yang, Chongtu
Chen, Yang
Wang, Chaoyang
Liu, Jiacheng
Huang, Songjiang
Zhou, Chen
Wang, Yingliang
Ju, Shuguang
Li, Tongqiang
Bai, Yaowei
Yao, Wei
Xiong, Bin
author_sort Yang, Chongtu
collection PubMed
description BACKGROUND: Targeted puncture of an appropriate portal venous branch during transjugular intrahepatic portosystemic shunt (TIPS) procedure may reduce the risk of postprocedural overt hepatic encephalopathy (HE). This study aimed to describe blood distribution under portography and combined it with puncture site to determine portal flow diversion, and to evaluate its prognostic value in predicting post-TIPS overt HE. METHODS: In this retrospective analysis of patients with cirrhosis undergoing TIPS, we included 252 patients to describe blood distribution under portography and 243 patients to assess the association between portal flow diversion and post-TIPS overt HE. RESULTS: At the first stage, 51 (20.2%) patients were identified as type A (unilateral type with the right portal branch receives blood from splenic vein [SV]), 16 (6.4%) as type B (unilateral type with the right branch receives blood from superior mesenteric vein [SMV]) and 185 (73.4%) as type C (fully mixed type). At the second stage, 40 patients were divided into the SV group, 25 into the SMV group and 178 into the mixed group. Compared with the mixed group, the risk of post-TIPS overt HE was significantly higher in the SMV group (adjusted HR 3.70 [95% CI 2.01–6.80]; p < 0.001), whereas the SV group showed a non-significantly decreased risk (adjusted HR 0.57 [95% CI 0.22–1.48]; p = 0.25). Additionally, the SMV group showed a substantial increase in ammonia level at 3 days and 1 month after procedure. CONCLUSIONS: Our results support the clinical use of portal flow diversion for risk stratification and decision-making in the management of post-TIPS overt HE. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12876-022-02447-y.
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spelling pubmed-93361112022-07-30 Portal flow diversion based on portography is superior than puncture site in the prediction of overt hepatic encephalopathy after TIPS creation Yang, Chongtu Chen, Yang Wang, Chaoyang Liu, Jiacheng Huang, Songjiang Zhou, Chen Wang, Yingliang Ju, Shuguang Li, Tongqiang Bai, Yaowei Yao, Wei Xiong, Bin BMC Gastroenterol Research BACKGROUND: Targeted puncture of an appropriate portal venous branch during transjugular intrahepatic portosystemic shunt (TIPS) procedure may reduce the risk of postprocedural overt hepatic encephalopathy (HE). This study aimed to describe blood distribution under portography and combined it with puncture site to determine portal flow diversion, and to evaluate its prognostic value in predicting post-TIPS overt HE. METHODS: In this retrospective analysis of patients with cirrhosis undergoing TIPS, we included 252 patients to describe blood distribution under portography and 243 patients to assess the association between portal flow diversion and post-TIPS overt HE. RESULTS: At the first stage, 51 (20.2%) patients were identified as type A (unilateral type with the right portal branch receives blood from splenic vein [SV]), 16 (6.4%) as type B (unilateral type with the right branch receives blood from superior mesenteric vein [SMV]) and 185 (73.4%) as type C (fully mixed type). At the second stage, 40 patients were divided into the SV group, 25 into the SMV group and 178 into the mixed group. Compared with the mixed group, the risk of post-TIPS overt HE was significantly higher in the SMV group (adjusted HR 3.70 [95% CI 2.01–6.80]; p < 0.001), whereas the SV group showed a non-significantly decreased risk (adjusted HR 0.57 [95% CI 0.22–1.48]; p = 0.25). Additionally, the SMV group showed a substantial increase in ammonia level at 3 days and 1 month after procedure. CONCLUSIONS: Our results support the clinical use of portal flow diversion for risk stratification and decision-making in the management of post-TIPS overt HE. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12876-022-02447-y. BioMed Central 2022-07-29 /pmc/articles/PMC9336111/ /pubmed/35906529 http://dx.doi.org/10.1186/s12876-022-02447-y Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Yang, Chongtu
Chen, Yang
Wang, Chaoyang
Liu, Jiacheng
Huang, Songjiang
Zhou, Chen
Wang, Yingliang
Ju, Shuguang
Li, Tongqiang
Bai, Yaowei
Yao, Wei
Xiong, Bin
Portal flow diversion based on portography is superior than puncture site in the prediction of overt hepatic encephalopathy after TIPS creation
title Portal flow diversion based on portography is superior than puncture site in the prediction of overt hepatic encephalopathy after TIPS creation
title_full Portal flow diversion based on portography is superior than puncture site in the prediction of overt hepatic encephalopathy after TIPS creation
title_fullStr Portal flow diversion based on portography is superior than puncture site in the prediction of overt hepatic encephalopathy after TIPS creation
title_full_unstemmed Portal flow diversion based on portography is superior than puncture site in the prediction of overt hepatic encephalopathy after TIPS creation
title_short Portal flow diversion based on portography is superior than puncture site in the prediction of overt hepatic encephalopathy after TIPS creation
title_sort portal flow diversion based on portography is superior than puncture site in the prediction of overt hepatic encephalopathy after tips creation
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9336111/
https://www.ncbi.nlm.nih.gov/pubmed/35906529
http://dx.doi.org/10.1186/s12876-022-02447-y
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