Shunt dysfunction and mortality after transjugular intrahepatic portosystemic shunt (TIPS) in patients with portal hypertension.

IF 4.1 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Insights into Imaging Pub Date : 2024-08-07 DOI:10.1186/s13244-024-01768-8

Laura Büttner, Lisa Pick, Martin Jonczyk, Uli Fehrenbach, Federico Collettini, Timo Alexander Auer, Dirk Schnapauff, Maximilian De Bucourt, Gero Wieners, Bernhard Gebauer, Annette Aigner, Georg Böning

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引用次数: 0

Abstract

Objectives: Transjugular intrahepatic portosystemic shunt (TIPS) is a catheter-based, minimally invasive procedure to reduce portal hypertension. The aim of the study was to investigate dysfunction and mortality after TIPS and to identify factors associated with these events.

Methods: A retrospective analysis of 834 patients undergoing TIPS implantation in a single center from 1993-2018 was performed. Cumulative incidence curves were estimated, and frailty models were used to assess associations between potentially influential variables and time to dysfunction or death.

Results: 1-, 2-, and 5-year mortality rates were 20.9% (confidence interval (CI) 17.7-24.1), 22.5% (CI 19.1-25.8), and 25.0% (CI: 21.1-28.8), 1-year, 2-year, and 5-year dysfunction rates were 28.4% (CI 24.6-32.3), 38.9% (CI 34.5-43.3), and 52.4% (CI 47.2-57.6). The use of covered stents is a protective factor regarding TIPS dysfunction (hazard ratio (HR) 0.47, CI 0.33-0.68) but does not play a major role in survival (HR 0.95, CI 0.58-1.56). Risk factors for mortality are rather TIPS in an emergency setting (HR 2.78, CI 1.19-6.50), a previous TIPS dysfunction (HR 2.43, CI 1.28-4.62), and an increased Freiburg score (HR 1.45, CI 0.93-2.28).

Conclusion: The use of covered stents is an important protective factor regarding TIPS dysfunction. Whereas previous TIPS dysfunction, emergency TIPS implantation, and an elevated Freiburg score are associated with increased mortality. Awareness of risk factors could contribute to a better selection of patients who may benefit from a TIPS procedure and improve clinical follow-up with regard to early detection of thrombosis/stenosis.

Critical relevance statement: The use of covered stents reduces the risk of dysfunction after transjugular intrahepatic portosystemic shunt (TIPS). TIPS dysfunction, emergency TIPS placement, and a high Freiburg score are linked to higher mortality rates in TIPS patients.

Key points: The risk of dysfunction is higher for uncovered stents compared to covered stents. Transjugular intrahepatic portosystemic shunt dysfunction increases the risk of instantaneous death after the intervention. A higher Freiburg score increases the rate of death after the intervention. Transjugular intrahepatic portosystemic shunt implantations in emergency settings reduce survival rates.

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门静脉高压症患者经颈静脉肝内门体分流术（TIPS）后的分流功能障碍和死亡率。

目的：经颈静脉肝内门体分流术（TIPS经颈静脉肝内门体分流术（TIPS）是一种基于导管的微创手术，可降低门脉高压。研究旨在调查 TIPS 术后的功能障碍和死亡率，并找出与这些事件相关的因素：对 1993-2018 年间在一个中心接受 TIPS 植入术的 834 名患者进行了回顾性分析。估计了累积发病率曲线，并使用虚弱模型评估潜在影响变量与功能障碍或死亡时间之间的关联：1年、2年和5年死亡率分别为20.9%（置信区间（CI）17.7-24.1）、22.5%（CI 19.1-25.8）和25.0%（CI：21.1-28.8），1年、2年和5年功能障碍率分别为28.4%（CI 24.6-32.3）、38.9%（CI 34.5-43.3）和52.4%（CI 47.2-57.6）。使用有盖支架是TIPS功能障碍的保护因素（危险比（HR）0.47，CI 0.33-0.68），但对存活率的影响不大（HR 0.95，CI 0.58-1.56）。死亡率的风险因素是急诊情况下的 TIPS（HR 2.78，CI 1.19-6.50）、既往 TIPS 功能障碍（HR 2.43，CI 1.28-4.62）和弗莱堡评分增加（HR 1.45，CI 0.93-2.28）：结论：使用有盖支架是TIPS功能障碍的重要保护因素。结论：使用有盖支架是TIPS功能障碍的重要保护因素，而既往TIPS功能障碍、紧急植入TIPS和弗赖堡评分升高则与死亡率升高有关。对风险因素的认识有助于更好地选择可能从 TIPS 手术中获益的患者，并改善早期发现血栓/狭窄的临床随访：使用有盖支架可降低经颈静脉肝内门体分流术（TIPS）后出现功能障碍的风险。TIPS功能障碍、紧急TIPS置管和弗赖堡评分高与TIPS患者死亡率较高有关：要点：与有盖支架相比，无盖支架发生功能障碍的风险更高。经颈静脉肝内门体分流术功能障碍会增加介入治疗后当场死亡的风险。弗赖堡评分越高，介入治疗后的死亡率越高。在紧急情况下植入经颈静脉肝内门体分流术会降低存活率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Insights into Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

7.30

自引率

4.30%

发文量

182

审稿时长

13 weeks

期刊介绍： Insights into Imaging (I³) is a peer-reviewed open access journal published under the brand SpringerOpen. All content published in the journal is freely available online to anyone, anywhere! I³ continuously updates scientific knowledge and progress in best-practice standards in radiology through the publication of original articles and state-of-the-art reviews and opinions, along with recommendations and statements from the leading radiological societies in Europe. Founded by the European Society of Radiology (ESR), I³ creates a platform for educational material, guidelines and recommendations, and a forum for topics of controversy. A balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes I³ an indispensable source for current information in this field. I³ is owned by the ESR, however authors retain copyright to their article according to the Creative Commons Attribution License (see Copyright and License Agreement). All articles can be read, redistributed and reused for free, as long as the author of the original work is cited properly. The open access fees (article-processing charges) for this journal are kindly sponsored by ESR for all Members. The journal went open access in 2012, which means that all articles published since then are freely available online.