2033. Left vs. Right? A Comparison of Transjugular Intrahepatic Portosystemic Shunt Portal Vein Access Sites
Authors* Denotes Presenting Author
Merve Ozen *;
University of Kentucky
Graham Meek;
University of Kentucky
Gaby Gabriel;
University of Kentucky
Chadi Diab;
University of Kentucky
Andrew Shabila;
University of Kentucky
Roberto Galuppo;
University of Kentucky
Driss Raissi;
University of Kentucky
Objective:
To evaluate the safety and efficacy of left and right portal vein puncture sites during transjugular intrahepatic portosystemic shunt (TIPS).
Materials and Methods:
A retrospective review included 64 patients with ePTFE-covered TIPS stents who underwent TIPS revision. The patients were divided into two groups according to the puncture site of the portal vein: left portal vein (n = 9), right portal vein (n = 55). We assessed patient demographics, comorbidities, and procedural information. The Kaplan-Meier and Cox regression analyses were performed to assess the effect of right vs. left portal vein access sites on primary patency. Thirty-day mortality and readmission, and mortality rates were compared for right and left portal vein groups.
Results:
There were a total 64 patients (42 men, 22 women, age-range 31 – 81 years). The mean follow-up time was 12.24 months (SD = 15.26, median = 6 months, range 0 – 68 months). Out of 64 patients, 28.1% of the patients had a history of Hep-C cirrhosis, 43.8% had alcoholic cirrhosis, and 4.7% had Hep-B cirrhosis. While no patients expired within 30 days in the right portal vein group, one patient expired in the left portal vein group within 30-days (n =1). The primary patency rate at 3 months was 63.6%, at 6 months was 50.9%, and at 12 months was 32.7% in the right portal group, and the left portal group rates were 77.8% at 3 months, 44.4% at 6 months, and 11.1% at 12 months. The Cox regression analysis showed no significant difference in the primary patency rate of the right portal vein group relative to the left portal vein group (hazard ratio 1.724; p = 0.149). There was no significant difference in survival of the right portal vein group relative to the left portal vein group (hazard ratio 1.321^9; p = 0.999).
Conclusion:
Choosing the left portal vein as the puncture site to create the shunt in TIPS with ePTFE-covered stents has no effect on primary TIPS shunt patency and 30-day mortality.
