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Safety and efficacy of transfemoral intrahepatic portosystemic shunt for portal hypertension: A single-center retrospective study

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World Journal of Clinical Cases 2019年第12期7卷 1410-1420页

作者： 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 MedicineBeijing Shijitan Hospital and Capital Medical University

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%

关键词： Transjugular intraheptic portosystemic shunt Transfemoral intraheptic portosystemic shunt Portal hypertension Variceal bleeding

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