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High Incidence of Hepatic Encephalopathy After Viatorr Controlled Expansion Transjugular Intrahepatic Portosystemic Shunt Creation

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Abstract

Background

The Viatorr Controlled Expansion (VCX) stent-graft was designed to mitigate hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation.

Aims

To determine the incidence and degree of HE after VCX TIPS.

Methods

Thirty-three patients (M:F 17:16, mean age 58 years, mean MELD score 12) who underwent VCX TIPS between 2018 and 2019 were retrospectively studied. 11/33 (33%) patients had medically controlled pre-TIPS HE. TIPS indications included variceal hemorrhage (n = 12, 30%) and ascites (n = 21, 70%). Measured outcomes were post-TIPS HE (overall, recurrent, de novo) graded using the West Haven system, time-to-HE occurrence, HE-related hospitalization rate, and TIPS reduction rate.

Results

VCX TIPS were 8 mm in 28/33 (85%) and 10 mm in 5/33 (15%). Mean final portosystemic pressure gradient was 6 mmHg. Cumulative HE incidence post-TIPS was 61% (20/33). 1-, 3-, 6-, and 12-month HE rates were 24%, 30%, 53%, and 61% over 247-day median follow-up. Median time-to-HE was 180 days. HE grades spanned grade 1 (n = 6), grade 2 (n = 8), and grade 3 (n = 6); 9 and 11 cases were recurrent and de novo HE, respectively. Medication non-compliance/infection was implicated in HE in 9/20 (45%) cases. Medical therapy addressed HE in 18/20 (90%) cases; however, HE still resulted in 39 hospitalizations among 13 patients, and median time to first hospitalization was 75 days. Shunt reduction was necessary in 2 (10%) cases of medically refractory HE.

Conclusions

The incidence of HE after VCX TIPS is high. Though HE symptoms may be medically controlled, hospitalization rates are high, and shunt reduction may be necessary.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. College of Medicine, University of Illinois at Chicago, Chicago, USA

    Marie-Louise Kloster, Ketan Y. Shah, Murad M. Alqadi, James T. Bui, Andrew J. Lipnik, Matthew M. Niemeyer & Charles E. Ray

  2. Department of Radiology, University of Illinois at Chicago, 1740 West Taylor Street, MC 931, Chicago, IL, 60612, USA

    Albert Ren & Ron C. Gaba

Authors
  1. Marie-Louise Kloster
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  2. Albert Ren
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  3. Ketan Y. Shah
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  4. Murad M. Alqadi
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  5. James T. Bui
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  7. Matthew M. Niemeyer
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  9. Ron C. Gaba
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Correspondence to Ron C. Gaba.

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Conflict of interest

Disclosures not related to this work: Ron C. Gaba receives research support from Guerbet USA LLC, Janssen Research and Development LLC, the United States Department of Defense, and the United States National Institutes of Health. He serves as a consultant for Sus Clinicals, Inc.

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Kloster, ML., Ren, A., Shah, K.Y. et al. High Incidence of Hepatic Encephalopathy After Viatorr Controlled Expansion Transjugular Intrahepatic Portosystemic Shunt Creation. Dig Dis Sci 66, 4058–4062 (2021). https://doi.org/10.1007/s10620-020-06716-2

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  • DOI: https://doi.org/10.1007/s10620-020-06716-2

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