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- W2916292099 abstract "Maximally decreasing portal pressures after transjugular intrahepatic portosystemic shunt (TIPS) placement is associated with improved outcomes for refractory ascites, but also associated with substantial incidence of encephalopathy. As splenic venous flow also contributes to portal venous pressure, it is hypothesized that combining a small-diameter TIPS with splenic artery embolization could improve ascites while minimizing the incidence of encephalopathy as compared to customary 10 mm-diameter TIPS. We evaluated the outcomes of such a combination to manage refractory ascites in cirrhotic patients. Medical records from consecutive cirrhotic patients who underwent creation of a small-diameter (8 mm) TIPS and proximal splenic artery embolization for management of refractory ascites after 2018 were analyzed. Five patients (M:F=4:2; mean age 68 years) underwent TIPS creation with a controlled-expansion VIATORR stent-graft dilated to 8 mm, associated with proximal splenic artery embolization. MELD score, portal pressures, clinical data and imaging were reviewed. The procedure was technically successful in all five patients. Mean portosystemic gradient decreased from 18 to 9 after TIPS and to 7 after splenic artery embolization. Median length of stay was 2 days. Median MELD score was 14 preprocedure (n=5), 17.5 one day after the procedure (n=4) and 14 one month after the procedure (n=3). One patient had TIPS thrombosis that was managed with thrombectomy, stent extension and dilatation to 10 mm. Mean number of paracentesis per patient per month decreased from 2.6 to 0.2. Two patients had evidence of hepatic encephalopathy on clinical follow-up, successfully medically managed. No patient developed splenic infarcts or procedural complications. Combining small-diameter TIPS and splenic artery embolization is a promising option to manage refractory ascites in cirrhotic patients. Further follow-up, increased study population, and comparison to historical 10 mm-diameter TIPS controls will be performed to confirm if the incidence of encephalopathy is decreased." @default.
- W2916292099 created "2019-03-02" @default.
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- W2916292099 date "2019-03-01" @default.
- W2916292099 modified "2023-10-16" @default.
- W2916292099 title "03:45 PM Abstract No. 253 Small-diameter TIPS combined with splenic artery embolization in the management of refractory ascites in cirrhotic patients" @default.
- W2916292099 doi "https://doi.org/10.1016/j.jvir.2018.12.314" @default.
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