Minilaparotomy-Assisted Transmesenteric-Transjugular Intrahepatic Portosystemic Shunt

Comparison with Conventional Transjugular Approach

Hamed Jalaeian, Reza Talaie, Donna L D'Souza, Shayandokht Taleb, Siamak Noorbaloochi, Siobhan M Flanagan, David Hunter, Jafar Golzarian

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Abstract

Purpose: This study was performed to compare the intrahepatic shunt function outcome and procedural complications of minilaparotomy-assisted transmesenteric (MAT)-transjugular intrahepatic portosystemic shunt (TIPS) placement with the conventional transjugular method. Methods: This is a retrospective review of all patients who had a MAT or conventional TIPS procedure over a 6-year period at our institute. The primary patency rate, fluoroscopy time, technical success, major procedure-related complications, and mortality data were compared between two treatment groups. Results: We included 49 patients with MAT-TIPS, and 63 with conventional TIPS, with an average follow-up of 21.43 months. The primary patency rates at 6 and 12 months were 82.9 and 66.7 % in the conventional TIPS group, and 81.0 and 76.5 % in the MAT-TIPS group (p = 1.000, and 0.529), respectively. There was no significant difference in technical success rate, post-procedure portosystemic pressure gradient, fluoroscopy time, and peri-procedural mortality rate between treatment groups. Major procedural-related complications were seen more frequently among MAT-TIPS patients (p = 0.012). In the MAT-TIPS group, 5 (10.2 %) patients developed post-procedure minilaparotomy, wound-related complications, and 5 (10.2 %) developed bacterial peritonitis; whereas, none of patients with conventional TIPS had either of these complications (p = 0.014). Conclusion: While both MAT-TIPS and conventional TIPS had similar shunt primary patency rate and technical success rate, the MAT approach was associated with a significantly higher rate of minilaparotomy-related wound complications or infectious complications. These complications maybe prevented by a change in post-procedure monitoring and therapy.

Original languageEnglish (US)
Pages (from-to)1413-1419
Number of pages7
JournalCardiovascular and Interventional Radiology
Volume39
Issue number10
DOIs
StatePublished - Oct 1 2016

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Transjugular Intrahepatic Portasystemic Shunt
Laparotomy
Fluoroscopy
Mortality
Wounds and Injuries
Peritonitis
Therapeutics

Keywords

  • MAT-TIPS
  • Minilaparotomy
  • Transjugular intrahepatic portosystemic shunt

Cite this

@article{1ff5519de1774a0ab7f3be2c6bf964fe,
title = "Minilaparotomy-Assisted Transmesenteric-Transjugular Intrahepatic Portosystemic Shunt: Comparison with Conventional Transjugular Approach",
abstract = "Purpose: This study was performed to compare the intrahepatic shunt function outcome and procedural complications of minilaparotomy-assisted transmesenteric (MAT)-transjugular intrahepatic portosystemic shunt (TIPS) placement with the conventional transjugular method. Methods: This is a retrospective review of all patients who had a MAT or conventional TIPS procedure over a 6-year period at our institute. The primary patency rate, fluoroscopy time, technical success, major procedure-related complications, and mortality data were compared between two treatment groups. Results: We included 49 patients with MAT-TIPS, and 63 with conventional TIPS, with an average follow-up of 21.43 months. The primary patency rates at 6 and 12 months were 82.9 and 66.7 {\%} in the conventional TIPS group, and 81.0 and 76.5 {\%} in the MAT-TIPS group (p = 1.000, and 0.529), respectively. There was no significant difference in technical success rate, post-procedure portosystemic pressure gradient, fluoroscopy time, and peri-procedural mortality rate between treatment groups. Major procedural-related complications were seen more frequently among MAT-TIPS patients (p = 0.012). In the MAT-TIPS group, 5 (10.2 {\%}) patients developed post-procedure minilaparotomy, wound-related complications, and 5 (10.2 {\%}) developed bacterial peritonitis; whereas, none of patients with conventional TIPS had either of these complications (p = 0.014). Conclusion: While both MAT-TIPS and conventional TIPS had similar shunt primary patency rate and technical success rate, the MAT approach was associated with a significantly higher rate of minilaparotomy-related wound complications or infectious complications. These complications maybe prevented by a change in post-procedure monitoring and therapy.",
keywords = "MAT-TIPS, Minilaparotomy, Transjugular intrahepatic portosystemic shunt",
author = "Hamed Jalaeian and Reza Talaie and D'Souza, {Donna L} and Shayandokht Taleb and Siamak Noorbaloochi and Flanagan, {Siobhan M} and David Hunter and Jafar Golzarian",
year = "2016",
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day = "1",
doi = "10.1007/s00270-016-1385-3",
language = "English (US)",
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pages = "1413--1419",
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issn = "7415-5101",
publisher = "Springer Verlag",
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TY - JOUR

T1 - Minilaparotomy-Assisted Transmesenteric-Transjugular Intrahepatic Portosystemic Shunt

T2 - Comparison with Conventional Transjugular Approach

AU - Jalaeian, Hamed

AU - Talaie, Reza

AU - D'Souza, Donna L

AU - Taleb, Shayandokht

AU - Noorbaloochi, Siamak

AU - Flanagan, Siobhan M

AU - Hunter, David

AU - Golzarian, Jafar

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Purpose: This study was performed to compare the intrahepatic shunt function outcome and procedural complications of minilaparotomy-assisted transmesenteric (MAT)-transjugular intrahepatic portosystemic shunt (TIPS) placement with the conventional transjugular method. Methods: This is a retrospective review of all patients who had a MAT or conventional TIPS procedure over a 6-year period at our institute. The primary patency rate, fluoroscopy time, technical success, major procedure-related complications, and mortality data were compared between two treatment groups. Results: We included 49 patients with MAT-TIPS, and 63 with conventional TIPS, with an average follow-up of 21.43 months. The primary patency rates at 6 and 12 months were 82.9 and 66.7 % in the conventional TIPS group, and 81.0 and 76.5 % in the MAT-TIPS group (p = 1.000, and 0.529), respectively. There was no significant difference in technical success rate, post-procedure portosystemic pressure gradient, fluoroscopy time, and peri-procedural mortality rate between treatment groups. Major procedural-related complications were seen more frequently among MAT-TIPS patients (p = 0.012). In the MAT-TIPS group, 5 (10.2 %) patients developed post-procedure minilaparotomy, wound-related complications, and 5 (10.2 %) developed bacterial peritonitis; whereas, none of patients with conventional TIPS had either of these complications (p = 0.014). Conclusion: While both MAT-TIPS and conventional TIPS had similar shunt primary patency rate and technical success rate, the MAT approach was associated with a significantly higher rate of minilaparotomy-related wound complications or infectious complications. These complications maybe prevented by a change in post-procedure monitoring and therapy.

AB - Purpose: This study was performed to compare the intrahepatic shunt function outcome and procedural complications of minilaparotomy-assisted transmesenteric (MAT)-transjugular intrahepatic portosystemic shunt (TIPS) placement with the conventional transjugular method. Methods: This is a retrospective review of all patients who had a MAT or conventional TIPS procedure over a 6-year period at our institute. The primary patency rate, fluoroscopy time, technical success, major procedure-related complications, and mortality data were compared between two treatment groups. Results: We included 49 patients with MAT-TIPS, and 63 with conventional TIPS, with an average follow-up of 21.43 months. The primary patency rates at 6 and 12 months were 82.9 and 66.7 % in the conventional TIPS group, and 81.0 and 76.5 % in the MAT-TIPS group (p = 1.000, and 0.529), respectively. There was no significant difference in technical success rate, post-procedure portosystemic pressure gradient, fluoroscopy time, and peri-procedural mortality rate between treatment groups. Major procedural-related complications were seen more frequently among MAT-TIPS patients (p = 0.012). In the MAT-TIPS group, 5 (10.2 %) patients developed post-procedure minilaparotomy, wound-related complications, and 5 (10.2 %) developed bacterial peritonitis; whereas, none of patients with conventional TIPS had either of these complications (p = 0.014). Conclusion: While both MAT-TIPS and conventional TIPS had similar shunt primary patency rate and technical success rate, the MAT approach was associated with a significantly higher rate of minilaparotomy-related wound complications or infectious complications. These complications maybe prevented by a change in post-procedure monitoring and therapy.

KW - MAT-TIPS

KW - Minilaparotomy

KW - Transjugular intrahepatic portosystemic shunt

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SN - 7415-5101

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