Paul San Harrod-Kim MD, Presenter: Nothing to Disclose

Wael E. A. Saad, Abstract Co-Author: Nothing to Disclose

Nikhil C Patel MD, Abstract Co-Author: Nothing to Disclose

Talia Sasson MD, Abstract Co-Author: Nothing to Disclose

David Edward Lee MD, Abstract Co-Author: Nothing to Disclose

David L Waldman MD, PhD, Abstract Co-Author: Nothing to Disclose

To determine if variceal embolization during TIPS reduces the risk of rebleeding.

129 patients underwent TIPS for variceal hemorrhage (33 with embolization; 96 with TIPS alone). Average follow-up was 7.8 months. The Kaplan-Meier and logrank tests were used to calculate rebleeding rates and detect differences between the 2 groups. Post-TIPS gradients were compared between the 2 groups and between rebleeders and non-rebleeders (Mann Whitney test). Because shunt dysfunction is a potential confounder, rebleeding rates were recalculated and compared after excluding patients with shunt stenosis at the time of rebleeding.

No significant difference in post-TIPS gradients existed between the 2 groups (embolization vs. TIPS alone; 8.0 vs. 9.0 mm Hg, p=0.101 ) or between rebleeders and non-rebleeders (8.0 vs. 9.0 mm Hg; p=0 .890). Rebleeding rates were not significantly different (39% of patients with embolization rebled vs. 25% in TIPS alone, p=0.415). 83.4% of rebleeders had their TIPS studied for patency at the time of rebleeding. 41.9% demonstrated stenosis. After their exclusion, there remained no significant difference in rebleeding rates (25.9% embolization vs. 19.3% TIPS alone, p=0.426).

Variceal embolization may not significantly alter rebleeding risk if the post-shunt portosystemic gradient is acceptable.

Harrod-Kim, P, Saad, W, Patel, N, Sasson, T, Lee, D, Waldman, D, Re-Bleeding after TIPS: Does Variceal Embolization Make a Difference?.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4410430.html