Clinical application of Viatorr stent in upper gastrointestinal bleeding with portal hypertension

doi:10.3877/cma.j.issn.2095-5782.2018.03.012

Abstract

Abstract:

Objective:

To observe the clinical effects of Viatorr stent used in transjugular intrahepatic portosystemic shunt (TIPS) for treating upper gastrointestinal bleeding with portal hypertension.

Methods:

Seventeen patients with portal hypertension combined with variceal hemorrhage using Viatorr stent in our hospital from November 2016 to October 2017 were included. The clinical effects and rate of complications were analyzed through comparing the portosystemic gradient (PSG) , total bilirubin, human albumin and prothrombin time before and after 1 d and 1 week of TIPS. In addition, the clinical follow-up of the patency rate of Viatorr stent and recurrence of hemorrhage were conducted.

Results:

Seventeen patients were operated successfully in one time and the success rate of the technique was 100%. The PSG before and after TIPS were (25.47±5.77) and (14.47±3.39) mmHg (t=12.015, P<0.05) . The blood ammonia after 1 d of TIPS was higher than that before TIPS (P<0.05) , but there was no significant difference between 1 week postoperation and pre-operation (P>0.05) . There was no significant difference of the total bilirubin, human albumin, glutamic oxalacetic transaminase, glutamic pyruvic transaminase and blood ammonia between 1 d and 1 week postoperation and pre-operation (P>0.05) . During the follow-up, 16 patients survived. One patient died after 52 d of operation because of pneumonia, and grade I or II hepatic encephalopathy occurred in 4 patients. All the patients never had haematemesis or melena. All the patients underwent color Doppler ultrasound or enhanced CT examination at 1 week and 3 months post-operation, and the results showed that all patients got smooth TIPS shunts till the end of follow-up visits (or before death) . The symptoms of ascites in two patients disappeared. Four patients underwent gastroscopy re-examination at 1-3 months after operation. The results showed that varicosed veins were relieved or disappeared.

Conclusions:

The usage of Viatorr stent can decrease the portal venous pressure and maintain the long-term circulation of shunts, reduce the rebreeding rate and keep the incidence of hepatic encephalopathy stay in control during the procedure of TIPS, so it is a safe and effective method for the treatment of patients with portal hypertension.

Key words: Viatorr stent, Portal hypertension, Upper gastrointestinal bleeding, Transjugular intrahepatic portosystemic shunt

Yanfeng Zhou, Zhuting Fang, Yi Tang, Shaojie Wu, Houlin Yang, Liangsheng Chen, Senlin Cai, Jianfeng He. Clinical application of Viatorr stent in upper gastrointestinal bleeding with portal hypertension[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2018, 06(03): 237-242.

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Figures/Tables 8

References 14

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时点	总胆红素(μmol/L)	白蛋白(g/L)	谷丙转氨酶(U/L)	谷草转氨酶(U/L)	血氨(μmol/L)	凝血酶原时间(s)
术前	25.59±13.76	30.18±4.57	56.32±12.50	43.77±9.92	40.60±8.14	16.42±2.01
术后1 d	27.88±11.57	30.12±5.13	49.52±13.80	44.22±8.24	55.38±9.27	15.38±1.21
t值	-0.525	0.036	1.506	-0.144	-4.340	1.828
P值	0.603	0.972	0.142	0.886	0.001	0.077

时点	总胆红素(μmol/L)	白蛋白(g/L)	谷丙转氨酶(U/L)	谷草转氨酶(U/L)	血氨(μmol/L)	凝血酶原时间(s)
术前	25.59±13.76	30.18±4.57	56.32±12.50	43.77±9.92	40.60±8.14	16.42±2.01
术后1 d	27.88±11.57	30.12±5.13	49.52±13.80	44.22±8.24	55.38±9.27	15.38±1.21
t值	-0.525	0.036	1.506	-0.144	-4.340	1.828
P值	0.603	0.972	0.142	0.886	0.001	0.077

时点	总胆红素(μmol/L)	白蛋白(g/L)	谷丙转氨酶(U/L)	谷草转氨酶(U/L)	血氨(μmol/L)	凝血酶原时间(s)
术前	25.59±13.76	30.18±4.57	56.32±12.50	43.77±9.92	40.60±8.14	16.42±2.01
术后1周	30.22±9.30	32.33±6.76	47.32±13.20	39.81±10.74	34.77±5.01	16.77±3.59
t值	-1.149	-1.086	1.841	1.117	1.915	-0.351
P值	0.259	0.286	0.073	0.272	0.064	0.728

时点	总胆红素(μmol/L)	白蛋白(g/L)	谷丙转氨酶(U/L)	谷草转氨酶(U/L)	血氨(μmol/L)	凝血酶原时间(s)
术前	25.59±13.76	30.18±4.57	56.32±12.50	43.77±9.92	40.60±8.14	16.42±2.01
术后1周	30.22±9.30	32.33±6.76	47.32±13.20	39.81±10.74	34.77±5.01	16.77±3.59
t值	-1.149	-1.086	1.841	1.117	1.915	-0.351
P值	0.259	0.286	0.073	0.272	0.064	0.728

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