Efficacy of Left Portal Vein Transjugular Intrahepatic Portosystemic Shunt Creation as a Strategy to Mitigate Hepatic Encephalopathy in High-Risk Patients

Wednesday, April 2, 2025

10:39 AM – 10:48 AM CT

Location: Music City Center, 208 AB

Presenting Author(s)

ZF

Zohaa Faiz, MBBS

Post Doctoral Research Fellow
Beth Israel Deaconess Medical Center, United States

Author/Co-author(s)

Vijay Ramalingam, MD

Vascular Interventional Radiologist
Beth Israel Deaconess Medical Center, United States
MT

Muhammad Mohid Tahir, MD

PGY-1 Preliminary Internal Medicine Resident
Icahn School of Medicine at Mount Sinai - Elmhurst Hospital Center, United States
Jeffrey Weinstein, MD, FSIR

Assistant Professor of Radiology
Beth Israel Deaconess Medical Center, United States
Lauren M. Yang, MD (she/her/hers)

Multidisciplinary Splanchnic Venous Thrombosis Program, Co-director
Beth Israel Deaconess Medical Center, United States
DH

Dora Huang, MD

Clinical Fellow in Gastroenterology
Beth Israel Deaconess Medical Center, United States
Ammar Sarwar, MD, FSIR (he/him/his)

Associate Professor of Radiology
Beth Israel Deaconess Medical Center, United States
MA

Muneeb Ahmed, MD, FSIR

Professor of Radiology
Beth Israel Deaconess Medical Center/Harvard, United States

Purpose: Hepatic encephalopathy (HE) occurs in up to 40% of patients after transjugular intrahepatic portosystemic shunt (TIPS) creation. This study aims to determine the incidence and degree of HE after left-to-left TIPS creation in patients otherwise deemed high risk for shunt candidacy .

Materials and Methods: This IRB-approved, single-center retrospective study analyzed 34 consecutive patients who underwent left-to-left TIPS between January 2016 and March 2023. A matched comparison (1:2) was conducted with 68 patients who received right-to-right TIPS. The matching was based on five variables: pre-TIPS HE grades, albumin levels, stent size, MELD score, and age. Procedural and clinical outcomes were assessed through chart review.

Results:
Over the seven-year period, 102 patients were evaluated. There were no statistically significant differences in baseline characteristics such as MELD score (p = 0.54), or presence of cirrhosis (p = 0.48). Post-TIPS complications were observed in 10 (29%) of the Left-to-Left group and 25 (37% ) of the Right-to-Right group, not statistically significant (p = 0.46).The complication are further detailed in Table 1.

The readmission rate was higher in the Left-to-Left group (32% vs. 16%, p=0.06), though this difference was not statistically significant. The most common cause of readmission in both groups was hepatic encephalopathy, occurring in 15% of patients in the Left-to-Left group and 7% in the Right-to-Right group.

The overall rate of HE was higher in the Left-to-Left group (68% vs. 57%, p=0.12). Rates of Grade 1 HE were the same in both groups (21% vs. 21%), while Grade 2 HE was slightly lower in the Left-to-Left group (29% vs. 32%). Grade 3 HE was more frequent in the Left-to-Left group (18% vs. 4%), but no Grade 4 HE was observed in either group. The rate of medical refractory HE was higher in the Left-to-Left group (15% vs. 9%, p=0.418), and the rate of shunt-related HE was also higher in the Left-to-Left group (15% vs. 5%, p=0.159). None of the differences were statistically significant.

Conclusion: There is no significant difference in the rates of hepatic encephalopathy observed between left-to-left TIPS and right-to-right TIPS procedures.