Procedural and shunt‐related complications and mortality of the transjugular intrahepatic portosystemic shunt (TIPSS)

Summary Background The implantation of a transjugular intrahepatic portosystemic shunt (TIPSS) is a complex angiographic procedure performed in patients with end‐stage liver disease. Numerous case reports and narrative reviews have been published so far; however, studies systematically investigating procedural and shunt‐related complications are lacking. Aim To systematically investigate complications and mortality occurring during the index hospital stay and the early (4‐week) period after TIPSS implantation. Methods The study includes 389 patients who received a TIPSS implantation between 2004 and 2014. Data were obtained from the clinical records and technical reports of the TIPSS implantation. Results During the index hospital stay, procedure‐related complications occurred in 42 patients (10.8%) with intraperitoneal bleeding in 8 patients (2.1%) and infections in 14 patients (3.6%). Shunt‐ and disease‐related complications consisted of hepatic encephalopathy (1‐year incidence 29%), non‐procedural infections (8.7%) and acute hepatic decompensation (4.1%). Nine patients (2.3%) died during the index hospital stay from procedure‐related (two patients, 0.5%), shunt‐related (four patients, 1%) or disease‐related causes (three patients, 0.8%). 23 patients (5.9%) died during 4 weeks after TIPSS implantation. The 1‐year probability of survival was 67.7% and was negatively associated with severe hepatic encephalopathy and acute hepatic decompensation. Conclusions Except hepatic encephalopathy, severe procedure‐ and shunt‐related complications are rare and early mortality is low.