Reduction in portal venous pressure by transjugular intrahepatic portosystemic shunt for treatment of hemorrhagic stomal varices

Amy R. Deipolyi, Sanjeeva P. Kalva, Rahmi Oklu, T. Gregory Walker, Stephan Wicky, Suvranu Ganguli

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

OBJECTIVE. Stomal varices can cause life-threatening gastrointestinal hemorrhage in patients with portal hypertension. Optimal therapy is not well defined. The purpose of this study was to determine the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation for the treatment of hemorrhagic stomal varices. MATERIALS AND METHODS. All patients who underwent TIPS creation for hemorrhagic stomal varices refractory to medical or endoscopic therapy over a 20-year period (1992-2012) were included. Ten patients (mean age, 63 ± 12 years) were identified. Retrospective chart review was used to document demographic characteristics, procedure details, technical and clinical success, complications, recurrent hemorrhage, and need for repeat interventions. Patients underwent follow-up for an average of 2 years (range, 22 days-9.6 years). RESULTS. All patients had cirrhosis and portal hypertension. Average corrected sinusoidal pressures were 11 ± 2.4 mm Hg (range, 6-15 mm Hg) before TIPS placement and 4.3 ± 1.8 mm Hg (range, 2-8 mm Hg) after TIPS placement. Five patients (50%) underwent adjunctive embolization of stomal varices through the TIPS, which did not affect outcome. Complications included one patient each with a contrast allergy and renal failure. Six patients experienced complete resolution of bleeding without further intervention (60%). Four patients had recurrent stomal hemorrhage. Two of the four needed TIPS revision for occlusion; one underwent oversewing of the ostomy; and in one the hemorrhage resolved with conservative measures after confirmation of TIPS patency. CONCLUSION. TIPS creation, with or without adjunctive variceal embolization, is a safe and effective treatment of refractory hemorrhagic stomal varices. Reintervention for recurrent bleeding may be required and appears effective.

Original languageEnglish (US)
Pages (from-to)668-673
Number of pages6
JournalAmerican Journal of Roentgenology
Volume203
Issue number3
DOIs
StatePublished - Sep 1 2014

Fingerprint

Transjugular Intrahepatic Portasystemic Shunt
Portal Pressure
Varicose Veins
Hemorrhage
Therapeutics
Portal Hypertension
Ostomy
Gastrointestinal Hemorrhage
Renal Insufficiency
Hypersensitivity
Fibrosis
Demography
Safety
Pressure

Keywords

  • Embolization
  • Portal hypertension
  • Stomal varices
  • TIPS
  • Transjugular intrahepatic portosystemic shunt

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Reduction in portal venous pressure by transjugular intrahepatic portosystemic shunt for treatment of hemorrhagic stomal varices. / Deipolyi, Amy R.; Kalva, Sanjeeva P.; Oklu, Rahmi; Walker, T. Gregory; Wicky, Stephan; Ganguli, Suvranu.

In: American Journal of Roentgenology, Vol. 203, No. 3, 01.09.2014, p. 668-673.

Research output: Contribution to journalArticle

Deipolyi, Amy R. ; Kalva, Sanjeeva P. ; Oklu, Rahmi ; Walker, T. Gregory ; Wicky, Stephan ; Ganguli, Suvranu. / Reduction in portal venous pressure by transjugular intrahepatic portosystemic shunt for treatment of hemorrhagic stomal varices. In: American Journal of Roentgenology. 2014 ; Vol. 203, No. 3. pp. 668-673.
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AU - Kalva, Sanjeeva P.

AU - Oklu, Rahmi

AU - Walker, T. Gregory

AU - Wicky, Stephan

AU - Ganguli, Suvranu

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AB - OBJECTIVE. Stomal varices can cause life-threatening gastrointestinal hemorrhage in patients with portal hypertension. Optimal therapy is not well defined. The purpose of this study was to determine the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) creation for the treatment of hemorrhagic stomal varices. MATERIALS AND METHODS. All patients who underwent TIPS creation for hemorrhagic stomal varices refractory to medical or endoscopic therapy over a 20-year period (1992-2012) were included. Ten patients (mean age, 63 ± 12 years) were identified. Retrospective chart review was used to document demographic characteristics, procedure details, technical and clinical success, complications, recurrent hemorrhage, and need for repeat interventions. Patients underwent follow-up for an average of 2 years (range, 22 days-9.6 years). RESULTS. All patients had cirrhosis and portal hypertension. Average corrected sinusoidal pressures were 11 ± 2.4 mm Hg (range, 6-15 mm Hg) before TIPS placement and 4.3 ± 1.8 mm Hg (range, 2-8 mm Hg) after TIPS placement. Five patients (50%) underwent adjunctive embolization of stomal varices through the TIPS, which did not affect outcome. Complications included one patient each with a contrast allergy and renal failure. Six patients experienced complete resolution of bleeding without further intervention (60%). Four patients had recurrent stomal hemorrhage. Two of the four needed TIPS revision for occlusion; one underwent oversewing of the ostomy; and in one the hemorrhage resolved with conservative measures after confirmation of TIPS patency. CONCLUSION. TIPS creation, with or without adjunctive variceal embolization, is a safe and effective treatment of refractory hemorrhagic stomal varices. Reintervention for recurrent bleeding may be required and appears effective.

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