Comparison of post-procedural complication rates in patients post gunsight Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure with propensity score matched randomized controls post conventional TIPS procedure

Purpose: To compare post-procedural complication rates between patients undergoing gunsight Trans jugular Intrahepatic Portosystemic Shunt (TIPS) and propensity score-matched controls undergoing conventional TIPS.

Materials and Methods:
Single center cross sectional retrospective analysis of 40 cirrhotic patients [10 Female(F), 30 Male(M), Mean-age 61.3 years+/-11.3] who underwent TIPS (7-Rescue, 7-salvage, 26-elective) for refractory ascites (22), variceal hemorrhage (13) and miscellaneous causes (6) was performed. 20 patients who underwent gunsight TIPS procedure were placed in Group-1 (G1: 6F, 14M, Mean-age 62.95+/-10.29, Mean MELD 17.45+/-6.9, Mean MELD-Na 17.75+/-6.5). Each patient was propensity-score matched with randomized controls in Group-2 (G2: 4F, 16M, Mean-age 59.7yrs+/-12.24) including patients with similar (p >0.05) MELD (17.65 +/-7.12) and MELD-Na scores (17.7+/-6.87) who underwent conventional TIPS. 30-day postprocedural complications described below and achieving indication for TIPS placement were compared for both groups. Statistical analysis was performed using Chi-square, Fisher’s-exact and paired t-tests.



Results: In each group, TIPS placement indication was achieved in 15/20 patients(p >0.05). Compared to group-2 (1/20), group-1 patients (6/20) experienced significantly (p=0.03) higher rates of 5-day post-procedural bleeding requiring imaging/repeat angiographic investigation. Of the patients that required repeat imaging in both groups, there were significant positive pertinent angiographic findings in group 1 patients (5/6, p=0.02).  No significant differences between both groups were noted in other post-procedural data assessed including 30-day postprocedural complications(G1:9/20, G2:8/20), non-iatrogenic complications (G1:4/9, G2:6/8), number of packed RBC’s transfused within 5 days post-procedure(G1:1.65+/-2.3; G2:2.35+/-4.0), infection rate(0/20 each), damage to surrounding structures (G1:3/20, G2:0/20) and 30-day mortality(G1:6/20, G2:7/20) [p >0.05 for all values].

Conclusion: Gunsight TIPS resulted in significantly higher post-procedural bleeding requiring angiographic investigation and pertinent angiographic findings compared to propensity score-matched conventional TIPS controls.