Analysis of Viatorr stent in the treatment of cirrhotic portal hypertension with upper gastrointestinal bleeding during TIPS

Abstract

Abstract: Objective To observe the clinical efficacy and safety of Viatorr stent during transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhotic portal hypertension (PHT) with upper gastrointestinal bleeding (UGB).Methods 32 patients with cirrhotic PHT and UGB treated in the hospital from November 2017 to December 2020 were selected as the research subjects, all patients were treated with Viatorr stent during TIPS and followed up in the clinic; the success rate of Viatorr stent implantation of patients was observed. The preoperative and postoperative portal vein pressure indexes [portal vein pressure gradient (PPG), portal vein pressure (PVP), portal vein velocity (PVV)] of patients were compared, changes of blood routine indexes [platelet count (PLT), hemoglobin (Hb), leukocyte count (WBC)], liver and kidney function indexes [alanine aminotransferase (ALT), aspartate aminotransferase (AST), Albumin (Alb), total bilirubin (TBil), serum creatinine (Scr), urea nitrogen (BUN)] and coagulation function indexes [prothrombin time (PT)] were observed before operation, 1 week, 1 month and 6 months after operation. The incidence of adverse events such as rebleeding, hepatic encephalopathy and shunt stenosis of patients within 6 months after operation were counted.Results 32 patients with PHT and UGB were successfully implanted with Viatorr stent, and the success rate was 100% (32/32); 3 days after operation, PVV and PVP were (51.28 ± 10.46) cm/s and (2.17 ± 0.63) mmHg, respectively, higher than those before operation (29.78 ± 7.65) cm/s and (3.32 ± 0.84) mmHg, and PPG was (12.75 ± 4.13) mmHg, lower than that before operation (21.46 ± 6.28) mmHg (P<0.05); from 1 week to 6 months after operation, the levels of PLT, Hb and WBC pf patients were gradually increased than those before operation (P<0.05); 1 week after operation, ALT, AST, TBil and PT of patients were increased and Alb was decreased than those before operation. 1 and 6 months after operation, ALT, AST, TBil and PT were gradually decreased, Alb was gradually increased (P<0.05); at 1 week, 1 month and 6 months after operation, Scr and BUN were significantly decreased than those before operation (P<0.05); during follow-up period, rebleeding occurred in 3 cases, with an incidence of 9.38% (3/32); and hepatic encephalopathy in 5 cases, with an incidence of 15.63% (5/32); shunt stenosis occurred in 6 cases, with an incidence of 18.75% (6/32).Conclusion The use of Viatorr stent in TIPS in the treatment of cirrhotic PHT with UGB can significantly reduce the postoperative portal venous pressure of patients, while the clinical effect is significant, and the risk of postoperative rebleeding, hepatic encephalopathy and shunt stenosis of patients is low.

Key words: Cirrhotic portal hypertension, Upper gastrointestinal bleeding, Transjugular intrahepatic portosystemic shunt, Viatorr stent, Liver function

YANG Mei-rong, CHEN Wei, DENG Jun, SUN Jun-kai, ZHOU Yan, JIANG Jun-lin, LI Shu-shu. Analysis of Viatorr stent in the treatment of cirrhotic portal hypertension with upper gastrointestinal bleeding during TIPS[J]. Chinese Hepatolgy, 2022, 27(11): 1189-1193.

References

[1] 高聪聪. TIPS联合PTVE用于肝硬化上消化道出血的疗效及对患者预后的影响. 肝脏,2019,24(12):1430-1432.
[2] Tripathi D, Stanley AJ, Hayes PC, et al. Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension. Gut,2020,69(7):1173-1192.
[3] 李旭, 王宏亮, 周坦洋, 等. 肝硬化伴门静脉血栓经颈静脉肝内门体分流术后分流道失功能的影响因素分析. 中华肝脏病杂志,2020,28(9):742-746.
[4] Geeratikun Y, Timmermans H, Uchida B, et al. VIDEO: Technique to Restrict the Gore Viatorr Stent-Graft for TIPS Reduction. AJR Am J Roentgenol,2018,210(4):172.
[5] 中华医学会外科学分会门静脉高压学组. 肝硬化门静脉高压症食管胃底静脉曲张破裂出血的诊治共识(2015版). 中华外科杂志,2015,53(12):917-921.
[6] 中华医学会消化病学分会消化介入学组. 经颈静脉肝内门体静脉分流术治疗肝硬化门静脉高压共识意见. 中华消化杂志,2014,34(1):3-6.
[7] 葛均波, 徐永健. 内科学.第8版. 北京:人民卫生出版社,2013:354.
[8] 马鹍鹏, 梁松年, 钟红珊, 等. Viatorr支架行TIPS术治疗门静脉高压性静脉曲张消化道出血效果评估. 介入放射学杂志,2020,29(4):380-384.
[9] 鲍应军, 顾俊鹏, 张海潇, 等. Viatorr支架与覆膜支架联合裸支架在TIPS治疗门静脉高压症中的疗效对比. 外科理论与实践,2019,24(6):517-521.
[10] Torsello G F, Herten M, M Müller, et al. In Vitro Evaluation of the Gore Viabahn Balloon-Expandable Stent-Graft for Fenestrated Endovascular Aortic Repair. J Endovasc Ther,2019,26(3):361-368.
[11] Qi X, Tian Y, Wei Z, et al. Covered versus bare stents for transjugular intrahepatic portosystemic shunt: an updated meta-analysis of randomized controlled trials. Therap Adv Gastroenterol,2017,10(1):32-41.
[12] Praktiknjo M, Lehmann J, Fischer S, et al. Novel diameter controlled expansion TIPS (Viatorr CX) graft reduces readmission compared to regular covered TIPS graft and bare metal graft. J Hepatol,2017,66(1):48-49.
[13] Lv Y, Yang Z, Liu L, et al. Early TIPS with covered stent versus standard treatment for acute variceal bleeding among patients with advanced cirrhosis: A randomised controlled trial. Lancet Gastroenterol Hepatol,2019,4(8):587-598.
[14] 丁智锋, 殷世武, 张国兵, 等. Viatorr支架与双支架技术行经颈静脉肝内门体分流术的临床疗效观察. 临床肝胆病杂志,2018,34(3):579-582.
[15] Tapper EB, Aberasturi D, Zhao Z, et al. Outcomes after hepatic encephalopathy in population‐based cohorts of patients with cirrhosis. Aliment Pharmacol Ther,2020,51(12):1397-1405.