Efficacy of TIPS plus extrahepatic collateral embolisation in real-world data: a validation study.

Area of Science:

• Hepatology
• Interventional Radiology
• Gastroenterology

Background:

• Transjugular intrahepatic portosystemic shunt (TIPS) is a key treatment for portal hypertension complications.
• Extrahepatic collateral embolisation (TIPS+E) may improve outcomes post-TIPS, but requires real-world validation.

Approach:

• A multicentre retrospective cohort study analyzed 2077 patients with cirrhosis undergoing TIPS±E.
• Propensity score matching (PSM) was used to compare outcomes between TIPS and TIPS+E groups.
• Prognostic models were developed using baseline data, and clinical outcomes were analyzed post-PSM.

Key Points:

• TIPS+E significantly reduced rebleeding, hepatic encephalopathy (HE), and further decompensation (FDC) compared to TIPS alone.
• Specific subgroups, including those using 8 mm stents and embolizing gastric varices with spontaneous portosystemic shunts (GV+SPSS), showed improved outcomes with TIPS+E.
• Optimal control of post-TIPS portal pressure gradient (pPPG) between 7-8.5 mm Hg enhanced prognosis, particularly in the TIPS+E group.

Conclusions:

• Real-world data validates the high efficacy of TIPS+E in reducing rebleeding and HE.
• TIPS+E is particularly beneficial when using 8 mm stents, embolizing GV+SPSS, and maintaining an optimal pPPG.
• These findings support TIPS+E as an effective strategy for managing complications of portal hypertension.