Rebleeding rates following TIPS for XXXX in the Viatorr era: TIPS alone versus TIPS with variceal embolization.

@entity1 @entity1575 @entity548
PURPOSE: To compare rebleeding rates following treatment of @entity548 with TIPS alone versus TIPS with variceal embolization in the covered stent-graft era. METHODS: In this retrospective study, 52 @entity1 (M:F 29:23, median age 52  years) with @entity1575 and @entity548 underwent TIPS insertion between 2003 and 2008. Median @entity1 -Pugh and MELD scores were 8.5 and 13.5. Generally, 10-mm diameter TIPS were created using covered stent-grafts (Viatorr; W.L. Gore and Associates, Flagstaff, AZ). A total of 37 @entity1 underwent TIPS alone, while 15 @entity1 underwent TIPS with variceal embolization. The rates of rebleeding and survival were compared. RESULTS: All TIPS were technically successful. Median portosystemic pressure gradient reductions were 13 versus 11  mmHg in the embolization and non-embolization groups. There were no statistically significant differences in @entity1 -Pugh and MELD score, or portosystemic pressure gradients between each group. A trend toward increased rebleeding was present in the non-embolization group, where 8/37 (21.6%) @entity1 rebled while 1/15 (6.7%) @entity1 in the TIPS with embolization group rebled (P  =  0.159) during median follow-up periods of 199 and 252  days (P  =  0.374). Rebleeding approached statistical significance among @entity1 with @entity548 , where 8/32 (25%) versus 0/14 (0%) rebled in the non-embolization and embolization groups (P  =  0.055). A trend toward increased bleeding-related mortality was seen in the non-embolization group (P  =  0.120). CONCLUSIONS: TIPS alone showed a high incidence of rebleeding in this series, whereas TIPS with variceal embolization resulted in reduced recurrent @entity548 . The efficacy of embolization during TIPS performed for @entity548 versus TIPS alone should be further compared with larger prospective randomized trials.
