Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2019; 7(12): 1410-1420
Published online Jun 26, 2019. doi: 10.12998/wjcc.v7.i12.1410
Safety and efficacy of transfemoral intrahepatic portosystemic shunt for portal hypertension: A single-center retrospective study
Yu Zhang, Fu-Quan Liu, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He
Yu Zhang, Fu-Quan Liu, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100010, China
Author contributions: Liu FQ designed the research; Yue ZD, Zhao HW, Wang L, Fan ZH and He FL performed the research; Zhang Y analyzed the data and wrote the paper; Liu FQ critically revised the manuscript for important intellectual content.
Supported by Capital Health Development Scientific Research Project, No. 2018-1-2081.
Institutional review board statement: All patients involved in this study gave their informed consent. Institutional review board approval of our hospital was obtained for this study.
Informed consent statement: Written informed consent was waived from all subjects in this study.
Conflict-of-interest statement: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fu-Quan Liu, BCPS, MD, Director, Professor, Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, No. 10 Tie Yi Road, Yangfangdian, Haidian District, Beijing 100010, China. lfuquan@aliyun.com
Telephone: +86-13701179758
Received: March 8, 2019
Peer-review started: March 8, 2019
First decision: April 18, 2019
Revised: April 28, 2019
Accepted: May 11, 2019
Article in press: May 11, 2019
Published online: June 26, 2019
Abstract
BACKGROUND

Transfemoral intrahepatic portosystemic shunt (TFIPS) can be performed to treat portal hypertension. However, few studies have evaluated the safety and efficacy of this technique.

AIM

To retrospectively evaluate the safety and clinical outcomes of TFIPS and compare them with those of typical transjugular intrahepatic portosystemic shunt (TIPS).

METHODS

This retrospective study was approved by our hospital ethics committee. From November 2012 to November 2015, 19 patients who underwent successful TFIPS placement were included. In addition, 21 patients treated with TIPS during the same period were selected as controls. Data collected included the success rate and complications of TIPS and TFIPS. Continuous data were expressed as the mean ± SD and were compared using the Student’s t test. All categorical data were expressed as count (percentage) and were compared using the χ2 test or Fisher’s exact test. The Kaplan–Meier method was used to calculate cumulative survival rate and survival curves.

RESULTS

Baseline characteristics were comparable between the two groups. The success rate of TFIPS and TIPS was 95% (19/20) and 100% (21/21), respectively. Effective portal decompression and free antegrade shunt flow was completed in all patients. The portal pressure gradient prior to TIPS and TFIPS placement was 23.91 ± 4.64 mmHg and 22.61 ± 5.39 mmHg, respectively, and it was significantly decreased to 10.85 ± 3.33 mmHg and 10.84 ± 3.33 mmHg after stent placement, respectively. Time–to-event calculated rates of shunt patency at one and two years in the TFIPS and TIPS groups were not statistically different (94.7% vs 95.2% and 94.7% vs 90.5%, respectively). De nova hepatic encephalopathy was 27.5% (11/40) with five patients in the TFIPS group (26.3%) and six patients (28.6%) in the TIPS group experiencing it (P = 0.873). The cumulative survival rates were similar between the two groups: 94.7% and 94.7% at 1 and 2 years, respectively, in the TFIPS group vs 100% and 95.2% at 1 and 2 years, respectively, in the TIPS group (P = 0.942).

CONCLUSION

TFIPS may be a valuable adjunct to traditional approaches in patients with portal hypertension.

Keywords: Transjugular intraheptic portosystemic shunt, Transfemoral intraheptic portosystemic shunt, Portal hypertension, Variceal bleeding

Core tip: Transjugular intrahepatic portosystemic shunt is currently an accepted therapy and has proved beneficial in the treatment of portal hypertension and their complications. However, exceptionally challenging anatomy may require unorthodox salvage techniques, such as transfemoral intrahepatic portosystemic shunt (TFIPS). Because of the rare use of TFIPS, there are few clinical trials that have assessed the safety and effectiveness of TFIPS. In this retrospective study, we describe the TFIPS procedure in detail and evaluate the safety and clinical outcomes of TFIPS and compare them with those of typical transjugular intrahepatic portosystemic shunt. The TFIPS procedure is feasible and efficacy in patients with unorthodox anatomy between the hepatic vein and the portal vein bifurcation.