| Transjugular intrahepatic portosystemic shunts: adjunctive embolotherapy of gastroesophageal collateral vessels in the prevention of variceal rebleeding. | |
| | |
MedLine Citation:
|
PMID: 15955858 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
PURPOSE: To prospectively compare rebleeding rates in patients treated with transjugular intrahepatic portosystemic shunt (TIPS) creation alone and those treated with TIPS creation combined with adjunctive embolotherapy of gastroesophageal collateral vessels. MATERIALS AND METHODS: Informed consent and ethics committee approval were obtained. Between November 1991 and November 2002, the authors prospectively followed up 95 consecutive patients (61 men, 34 women; age range, 30-81 years) with variceal bleeding due to cirrhosis and portal hypertension. The patients were divided into two groups on the basis of splenoportographic findings after TIPS creation. The patients were treated with TIPS alone (group 1, 42 patients) or in combination with variceal embolotherapy (group 2, 53 patients). Embolotherapy with sclerosing agents in combination with coils was performed when varices continued to fill and the pressure gradient was more than 12 mm Hg. Rebleeding was defined as any hemorrhage necessitating a transfusion of 2 or more units of blood. Estimates for the cumulative patency, survival, and rebleeding rates were calculated by using life-table analysis; the log-rank test was used to compare the two treatment modalities. The prognostic relevance of treatment and selected variables with respect to rebleeding and survival were analyzed with multiple logistic regression. RESULTS: Mean follow-up time (+/- standard deviation) was 48.7 months +/- 37.8 (range, 1-127 months). The proportion of patients (Kaplan-Meier estimation) with TIPS who remained free of bleeding was 61% after 2 years and 53% after 4 years. Patients who underwent both the TIPS procedure and embolotherapy remained free of bleeding in 84% of cases after 2 years and in 81% of cases after 4 years. With respect to the rebleeding rate, the difference between the groups was statistically significant (log-rank test, P = .02). Results of multiple logistic regression analysis showed that variceal embolotherapy significantly reduced the risk of rebleeding (Wald test, P < .001). CONCLUSION: The results suggest that TIPS and adjunctive embolotherapy of gastroesophageal collateral vessels significantly lower the rebleeding rate in comparison to TIPS alone. |
| | |
Authors:
|
I Kaare Tesdal; Thomas Filser; Christel Weiss; Eggert Holm; Christoph Dueber; Werner Jaschke |
Related Documents
:
|
3874508 - Oesophageal motility after sclerotherapy for bleeding varices. 1794268 - Efficacy of gliclazide in comparison with other sulphonylureas in the treatment of niddm. 3569808 - Late results in patients with schatzki ring treated by endoscopic electrosurgical incis... 2404448 - Endoscopic variceal sclerosis compared with distal splenorenal shunt to prevent recurre... 16488958 - Combined photodynamic therapy and intravitreal triamcinolone injection for the treatmen... 17309908 - Comparison of clinical and economic outcomes of two antibiotic prophylaxis regimens for... |
Publication Detail:
|
Type: Comparative Study; Journal Article Date: 2005-06-13 |
Journal Detail:
|
Title: Radiology Volume: 236 ISSN: 0033-8419 ISO Abbreviation: Radiology Publication Date: 2005 Jul |
Date Detail:
|
Created Date: 2005-06-30 Completed Date: 2005-08-04 Revised Date: 2006-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 0401260 Medline TA: Radiology Country: United States |
Other Details:
|
Languages: eng Pagination: 360-7 Citation Subset: AIM; IM |
Copyright Information:
|
Copyright RSNA, 2005 |
Affiliation:
|
Department of Clinical Radiology, Universitätsklinikum Mannheim, Germany. k.tesdal@krankenhaus-fn.de |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Aged, 80 and over Angiography Chi-Square Distribution Collateral Circulation Embolization, Therapeutic / methods* Esophageal and Gastric Varices / etiology, therapy* Female Follow-Up Studies Gastrointestinal Hemorrhage / etiology, therapy* Humans Hypertension, Portal / complications Liver Cirrhosis / complications Male Middle Aged Portasystemic Shunt, Transjugular Intrahepatic* Prospective Studies Recurrence Statistics, Nonparametric Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Accurate differentiation of focal nodular hyperplasia from hepatic adenoma at gadobenate dimeglumine...
Next Document: Differentiating malignant from benign common bile duct stricture with multiphasic helical CT.