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Left versus Right Portal Vein Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation in Patients with Grade 1
Vijay Ramalingam1, Ammar Sarwar1, Zohaa Faiz1
1Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts.
Purpose:
To evaluate whether left-sided transjugular intrahepatic portosystemic shunt (L-TIPS) placement offers an advantage over conventional right-sided transjugular intrahepatic portosystemic shunt (R-TIPS) in cirrhotic patients with a history of Grade 1 hepatic encephalopathy (HE), specifically in lowering the incidence and progression of HE.
Materials And Methods:
This institutional review board (IRB)-approved, single-center retrospective study analyzed 25 consecutive patients who underwent L-TIPS creation between January 2016 and March 2023 who had a history of Grade 1 HE. Using 1:2 matching for 5 variables (pre-transjugular intrahepatic portosystemic shunt HE grades, albumin levels, stent size, Model for End-stage Liver Disease [MELD] score, and age), 50 patients who received R-TIPS were selected for comparison of procedural and clinical outcomes.
Results:
Of the 75 patients, there were 25 in the L-TIPS group (age, 58.4 years [SD ± 6.8]; 72% male) and 50 in R-TIPS group (age, 58.8 years [SD ± 8.4]; 66% male; P = .828 for age; P = .600 for sex). Rates of HE stage escalation after transjugular intrahepatic portosystemic shunt placement were not significantly different between groups (48% L-TIPS vs 38% R-TIPS; P = .562). The rate of medically refractory HE was 4% in the L-TIPS group and 0% in the R-TIPS group. There was no significant difference in the number of adverse events between the 2 groups (P = .802).
Conclusions:
L-TIPS demonstrates a similar safety profile and similar rates of HE as R-TIPS in patients with pre-existing Grade 1 HE.
