Organ Distribution of 13N Following Intravenous Injection of [13N]Ammonia into Portacaval-Shunted Rats

Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy

BACKGROUND

Transjugular intrahepatic portosystemic shunt (TIPS) is currently used for the treatment of complications of portal hypertension. The incidence of hepatic encephalopathy (HE) remains a problem in TIPS placement. It has been reported that the right branch mainly receives superior mesenteric venous blood while the left branch mainly receives blood from the splenic vein. We hypothesized that targeted puncture of the left portal vein would divert the non-nutritive blood from the splenic vein into the TIPS shunt; therefore, targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE.

AIM

To evaluate the influence of targeted puncture of left branch of portal vein in TIPS on HE.

METHODS

A retrospective analysis of 1244 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2000 to January 2013 was performed. Patients were divided into group A (targeting left branch of portal vein, n = 937) and group B (targeting right branch of portal vein, n = 307). TIPS-related HE and clinical outcomes were analyzed.

RESULTS

The symptoms of ascites and variceal bleeding disappeared within a short time. By the endpoint of follow-up, recurrent bleeding and ascites did not differ significantly between groups A and B (P = 0.278, P = 0.561, respectively). Incidence of HE differed significantly between groups A and B at 1 mo (14.94% vs 36.80%, χ² = 4.839, P = 0.028), 3 mo (12.48% vs 34.20%, χ² = 5.054, P = 0.025), 6 mo (10.03% vs 32.24%, χ² = 6.560, P = 0.010), 9 mo (9.17% vs 31.27%, χ² = 5.357, P = 0.021), and 12 mo (8.21% vs 28.01, χ² = 3.848, P = 0.051). There were no significant differences between groups A and B at 3 years (6.61% vs 7.16%, χ² = 1.204, P = 0.272) and 5 years (5.01% vs 6.18%, χ² = 0.072, P = 0.562). The total survival rate did not differ between groups A and B (χ² = 0.226, P = 0.634, log-rank test).

CONCLUSION

Targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE but has no direct influence on prognosis of portal-hypertension-related complications.

[Prevention and treatment of hepatic encephalopathy]

Hepatic encephalopathy is a common neuropsychiatric complication of serious liver diseases and serves as a marker for worsening of their course and increasing the risk of death. The principal pathogenesis factors of hepatic encephalopathy is the excessive formation of ammonia and its accumulation by astrocytes. A key role in the prevention and treatment of hepatic encephalopathy is played by drugs that prevent hyperammonemia and promote the removal of ammonia from the body, namely lactulose, rifaximin and L-ornithine-L-aspartate. L-ornithine-L-aspartate has proven clinical effectiveness in the treatment of hepatic encephalopathy, prevents the transformation of minimal hepatic encephalopathy into overt forms, increases the tolerability of psychotropic drugs used in the treatment of alcohol dependence, and improves cognitive functions.