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Does the location of bleeding varices affect rebleeding risk after transjugular intrahepatic portosystemic shunt placement?
JVIR
’
Scientific Session
3:36 PM
Wednesday
Abstract No. 385
Does the location of bleeding varices affect rebleeding risk after transjugular intrahepatic portosystemic shunt placement? G. Laidlaw, M. Salahi, N. Moradzadeh, P. Jaju, D. Sze, G. Hwang; Stanford University Medical Center, Stanford, CA
3:45 PM
Abstract No. 386
MELD score does not underestimate short-term mortality risk in women versus men after TIPS creation N. Mendoza-Elias1, J. Morrison1, A. Lipnik2, R. Lokken3, J. Bui1, C. Ray4, R. Gaba1; 1University of Illinois Hospital, Chicago, IL; 2Vanderbilt University, Nashville, TN; 3 University of Illinois Chicago, Chicago, IL; 4University of Illinois Hospital and Health Sciences Center, Chicago, IL Purpose: The smaller build and reduced muscle mass of women compared to men may translate into lower Model for End-stage Liver Disease (MELD) scores for similar degrees of renal
S167
impairment as measured by creatinine. It is unclear whether this difference translates into underestimated MELD stratified risk and discrepant survival outcomes after transjugular intrahepatic portosystemic shunt (TIPS) creation. This study aimed to compare the post-TIPS short-term survival of women versus men matched for MELD risk category. Materials: In this single-center, IRB-approved retrospective observational study, 320 consecutive patients underwent TIPS creation between 1998-2016. Patients who underwent early liver transplant within 90-days of TIPS were excluded. The remaining patients were stratified by gender (female vs. male). 30- and 90-day mortality outcomes were then compared between MELD-matched risk groups (o11, 11-18, 19-25, and 425) using the independent samples t-test. Results: The final cohort included 303 patients (M:F 189:114, mean age 54 years). There were no differences in MELD scores (9 vs. 9, 14 vs. 14, 22 vs. 21, 33 vs. 33) or TIPS indication (% variceal hemorrhage) (79% vs. 89%, 48% vs. 48%, 53% vs. 54%, 65% vs. 57%) within MELD risk groups (P40.05 for all comparisons). Survival outcomes between women and men across MELD risk groups was similar (Table, P40.5 for all comparisons). Conclusions: Gender does not impact post-TIPS survival in patients matched for MELD risk category. MELD score does not underestimate mortality risk to women undergoing TIPS creation.
MELD Score
30-Day Mortality
90-Day Mortality
Rate (%) (F vs. M)
Rate (%) (F vs. M)
o11
0% vs. 7%
3% vs. 7%
11–18
13% vs. 7%
24% vs. 13%
19–25 425
19% vs. 19% 64% vs. 72%
30% vs. 31% 71% vs. 78%
3:54 PM
Abstract No. 387
Persistence of varices on CT or MR imaging and risk of variceal hemorrhage after transjugular intrahepatic portosystemic shunt with embolotherapy N. Moradzadeh1, G. Laidlaw1, M. Salahi1, P. Jaju1, D. Sze1, G. Hwang1, N. Moradzadeh2; 1Stanford University Medical Center, Stanford, CA; 2Stanford Hospital, Redwood City, CA Purpose: To determine whether the presence of visible varices on contrast-enhanced CT or MR imaging after TIPS with adjunctive procedures to occlude varices predicts future variceal bleeding. Materials: In this single-center, retrospective study, 121 patients underwent TIPS creation for variceal hemorrhage or ascites using ePTFE-covered stents with adjunctive variceal occlusion from Jan 2005 to Jun 2015. Patients without post-TIPS contrastenhanced CT or MR imaging were excluded (n ¼ 59). Patient demographics and post-TIPS outcomes were recorded,
WEDNESDAY: Scientific Sessions
Purpose: To determine whether the location of a culprit ruptured varix increases rebleeding risk after ePTFE-covered stent transjugular intrahepatic portosystemic shunt (TIPS) placement. Materials: We retrospectively reviewed 136 patients who underwent TIPS for acute variceal hemorrhage between Jan 2005 and Jun 2015. Varices were categorized as esophageal (E, n ¼ 71), gastric (G, n ¼ 52), or other (O, n ¼ 13; colonic, duodenal, parastomal, or rectal) based on endoscopic or surgical localization of identified hemorrhage. Patient ns demographics, MELD score, follow-up time, mean final portosystemic gradient (PSG), adjunctive procedures to occlude varices, and variceal rebleeding rates were recorded and analyzed. Continuous and categorical variables were analyzed using ANOVA, Chi-squared tests, Fisher’s exact tests, and logistic regression in SAS (SAS Institute, Cary, NC). Results: Demographic characteristics and pre-procedural MELD scores were similar among the 3 groups. Intraprocedurally, patients with gastric varices were more likely to undergo adjunctive procedures to occlude varices than patients with esophageal or other varices (54.9% E vs 78.9% G vs 69.2% O, p ¼ 0.03), though final PSG values were similar in each group (7.2 mmHg E vs 6.3 mmHg G vs 5.8 mmHg O, p ¼ 0.11). No significant difference in variceal rebleeding rates was evident (14.3% E vs 9.6% G vs 15.4% O, p ¼ 0.68). Similarly, rebleeding odds did not significantly differ after adjustment for intraprocedural adjunctive procedures to occlude varices (G vs E OR 0.85, p ¼ 0.79; O vs E OR 1.29, p ¼ 0.77). Mean follow-up times were similar among all groups (20.8 months E vs 15.5 months G vs 14.9 months O, p ¼ 0.48). Conclusions: The location of pre-TIPS variceal hemorrhage does not significantly affect rebleeding rates after TIPS creation for esophageal, gastric, or other varices. Data are limited by low number of adverse events and short followup interval.
’
’
Scientific Session
3:36 PM
Wednesday
Abstract No. 385
Does the location of bleeding varices affect rebleeding risk after transjugular intrahepatic portosystemic shunt placement? G. Laidlaw, M. Salahi, N. Moradzadeh, P. Jaju, D. Sze, G. Hwang; Stanford University Medical Center, Stanford, CA
3:45 PM
Abstract No. 386
MELD score does not underestimate short-term mortality risk in women versus men after TIPS creation N. Mendoza-Elias1, J. Morrison1, A. Lipnik2, R. Lokken3, J. Bui1, C. Ray4, R. Gaba1; 1University of Illinois Hospital, Chicago, IL; 2Vanderbilt University, Nashville, TN; 3 University of Illinois Chicago, Chicago, IL; 4University of Illinois Hospital and Health Sciences Center, Chicago, IL Purpose: The smaller build and reduced muscle mass of women compared to men may translate into lower Model for End-stage Liver Disease (MELD) scores for similar degrees of renal
S167
impairment as measured by creatinine. It is unclear whether this difference translates into underestimated MELD stratified risk and discrepant survival outcomes after transjugular intrahepatic portosystemic shunt (TIPS) creation. This study aimed to compare the post-TIPS short-term survival of women versus men matched for MELD risk category. Materials: In this single-center, IRB-approved retrospective observational study, 320 consecutive patients underwent TIPS creation between 1998-2016. Patients who underwent early liver transplant within 90-days of TIPS were excluded. The remaining patients were stratified by gender (female vs. male). 30- and 90-day mortality outcomes were then compared between MELD-matched risk groups (o11, 11-18, 19-25, and 425) using the independent samples t-test. Results: The final cohort included 303 patients (M:F 189:114, mean age 54 years). There were no differences in MELD scores (9 vs. 9, 14 vs. 14, 22 vs. 21, 33 vs. 33) or TIPS indication (% variceal hemorrhage) (79% vs. 89%, 48% vs. 48%, 53% vs. 54%, 65% vs. 57%) within MELD risk groups (P40.05 for all comparisons). Survival outcomes between women and men across MELD risk groups was similar (Table, P40.5 for all comparisons). Conclusions: Gender does not impact post-TIPS survival in patients matched for MELD risk category. MELD score does not underestimate mortality risk to women undergoing TIPS creation.
MELD Score
30-Day Mortality
90-Day Mortality
Rate (%) (F vs. M)
Rate (%) (F vs. M)
o11
0% vs. 7%
3% vs. 7%
11–18
13% vs. 7%
24% vs. 13%
19–25 425
19% vs. 19% 64% vs. 72%
30% vs. 31% 71% vs. 78%
3:54 PM
Abstract No. 387
Persistence of varices on CT or MR imaging and risk of variceal hemorrhage after transjugular intrahepatic portosystemic shunt with embolotherapy N. Moradzadeh1, G. Laidlaw1, M. Salahi1, P. Jaju1, D. Sze1, G. Hwang1, N. Moradzadeh2; 1Stanford University Medical Center, Stanford, CA; 2Stanford Hospital, Redwood City, CA Purpose: To determine whether the presence of visible varices on contrast-enhanced CT or MR imaging after TIPS with adjunctive procedures to occlude varices predicts future variceal bleeding. Materials: In this single-center, retrospective study, 121 patients underwent TIPS creation for variceal hemorrhage or ascites using ePTFE-covered stents with adjunctive variceal occlusion from Jan 2005 to Jun 2015. Patients without post-TIPS contrastenhanced CT or MR imaging were excluded (n ¼ 59). Patient demographics and post-TIPS outcomes were recorded,
WEDNESDAY: Scientific Sessions
Purpose: To determine whether the location of a culprit ruptured varix increases rebleeding risk after ePTFE-covered stent transjugular intrahepatic portosystemic shunt (TIPS) placement. Materials: We retrospectively reviewed 136 patients who underwent TIPS for acute variceal hemorrhage between Jan 2005 and Jun 2015. Varices were categorized as esophageal (E, n ¼ 71), gastric (G, n ¼ 52), or other (O, n ¼ 13; colonic, duodenal, parastomal, or rectal) based on endoscopic or surgical localization of identified hemorrhage. Patient ns demographics, MELD score, follow-up time, mean final portosystemic gradient (PSG), adjunctive procedures to occlude varices, and variceal rebleeding rates were recorded and analyzed. Continuous and categorical variables were analyzed using ANOVA, Chi-squared tests, Fisher’s exact tests, and logistic regression in SAS (SAS Institute, Cary, NC). Results: Demographic characteristics and pre-procedural MELD scores were similar among the 3 groups. Intraprocedurally, patients with gastric varices were more likely to undergo adjunctive procedures to occlude varices than patients with esophageal or other varices (54.9% E vs 78.9% G vs 69.2% O, p ¼ 0.03), though final PSG values were similar in each group (7.2 mmHg E vs 6.3 mmHg G vs 5.8 mmHg O, p ¼ 0.11). No significant difference in variceal rebleeding rates was evident (14.3% E vs 9.6% G vs 15.4% O, p ¼ 0.68). Similarly, rebleeding odds did not significantly differ after adjustment for intraprocedural adjunctive procedures to occlude varices (G vs E OR 0.85, p ¼ 0.79; O vs E OR 1.29, p ¼ 0.77). Mean follow-up times were similar among all groups (20.8 months E vs 15.5 months G vs 14.9 months O, p ¼ 0.48). Conclusions: The location of pre-TIPS variceal hemorrhage does not significantly affect rebleeding rates after TIPS creation for esophageal, gastric, or other varices. Data are limited by low number of adverse events and short followup interval.
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