REGULAR CONTENT
Final ID
546
Type
Original Scientific Research-Oral or Pos
Authors
N Moradzadeh1, G Laidlaw1, M Salahi1, P Jaju1, J Louie1, D Sze1, G Hwang1
Institutions
1Stanford University Medical Center, Stanford, CA
Purpose
To compare post-procedure complication and reintervention rates between direct intrahepatic portocaval shunts (DIPS) and transjugular intrahepatic portosystemic shunts (TIPS).
Materials & Methods
We retrospectively reviewed 299 patients who underwent DIPS (n=31, 10.4%) or TIPS (n=268, 89.6%) creation with ePTFE-covered stents between Jan 2005 and Jun 2015. Demographics, MELD score, procedural details, follow-up interval, and post-procedure variceal bleeding rates, complications and reinterventions were assessed. Continuous and categorical variables were analyzed using ANOVA, Chi-squared tests, Fisher's exact tests, and logistic regression with SAS software (SAS, Cary, NC).
Results
Pre-procedure demographics, indications, and MELD did not differ significantly. Excluding TIPS procedures that converted to DIPS (n=11), mean procedure time did not significantly differ (DIPS 166.9 min vs TIPS 165.7 min, p=0.95). Adjunctive procedures to occlude varices were performed at similar rates (DIPS 48.4% vs TIPS 39.9%, p=0.36). TIPS patients had slightly higher final portosystemic gradients (DIPS 5.4 mmHg vs TIPS 6.7 mmHg, p=0.03). 30-day overall complication rates were comparable (DIPS 45.2% vs TIPS 48.1%, p=0.75; adjusted OR 0.73, p=0.44). When stratified further, no significant differences in 30-day rates of bleeding complication (12.9% vs 6.3%, p=0.25), encephalopathy (25.8% vs 34.0%, p=0.36), sepsis (6.5% vs 4.1%, p=0.63), or death (9.7% vs 4.9%, p=0.22) were evident. 46 patients underwent reintervention after DIPS (n=7, 22.6%) and TIPS (n=39, 14.6%); DIPS patients trended towards a higher reintervention rate (p=0.28; adjusted OR 2.58, p=0.06). No significant differences in reintervention technique (parallel shunt placement, angioplasty, restenting, or reduction) were evident.
Conclusions
DIPS placement results in similar procedure times, 30-day post-procedure complication rates, and post-procedure reintervention rates when compared to TIPS. Data are limited by small sample size in the DIPS population and by short follow-up time.
Final ID
546
Type
Original Scientific Research-Oral or Pos
Authors
N Moradzadeh1, G Laidlaw1, M Salahi1, P Jaju1, J Louie1, D Sze1, G Hwang1
Institutions
1Stanford University Medical Center, Stanford, CA
Purpose
To compare post-procedure complication and reintervention rates between direct intrahepatic portocaval shunts (DIPS) and transjugular intrahepatic portosystemic shunts (TIPS).
Materials & Methods
We retrospectively reviewed 299 patients who underwent DIPS (n=31, 10.4%) or TIPS (n=268, 89.6%) creation with ePTFE-covered stents between Jan 2005 and Jun 2015. Demographics, MELD score, procedural details, follow-up interval, and post-procedure variceal bleeding rates, complications and reinterventions were assessed. Continuous and categorical variables were analyzed using ANOVA, Chi-squared tests, Fisher's exact tests, and logistic regression with SAS software (SAS, Cary, NC).
Results
Pre-procedure demographics, indications, and MELD did not differ significantly. Excluding TIPS procedures that converted to DIPS (n=11), mean procedure time did not significantly differ (DIPS 166.9 min vs TIPS 165.7 min, p=0.95). Adjunctive procedures to occlude varices were performed at similar rates (DIPS 48.4% vs TIPS 39.9%, p=0.36). TIPS patients had slightly higher final portosystemic gradients (DIPS 5.4 mmHg vs TIPS 6.7 mmHg, p=0.03). 30-day overall complication rates were comparable (DIPS 45.2% vs TIPS 48.1%, p=0.75; adjusted OR 0.73, p=0.44). When stratified further, no significant differences in 30-day rates of bleeding complication (12.9% vs 6.3%, p=0.25), encephalopathy (25.8% vs 34.0%, p=0.36), sepsis (6.5% vs 4.1%, p=0.63), or death (9.7% vs 4.9%, p=0.22) were evident. 46 patients underwent reintervention after DIPS (n=7, 22.6%) and TIPS (n=39, 14.6%); DIPS patients trended towards a higher reintervention rate (p=0.28; adjusted OR 2.58, p=0.06). No significant differences in reintervention technique (parallel shunt placement, angioplasty, restenting, or reduction) were evident.
Conclusions
DIPS placement results in similar procedure times, 30-day post-procedure complication rates, and post-procedure reintervention rates when compared to TIPS. Data are limited by small sample size in the DIPS population and by short follow-up time.