Correlation of spleen volume and portal pressure in patients undergoing TIPS.

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Maryam Boumezrag, MD

PGY-4 Resident
Medstar Georgetown University Hospital

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

SS

Saher S. Sabri, MD, FSIR

Chief of Interventional Radiology
MedStar Health
NF

Nathan E. Frenk, MD

Assistant Professor
Medstar Georgetown University Hospital
EC

Emil I. Cohen, MD, FSIR

Associate Professor
Medstar Georgetown University Hospital

Disclosure(s):

Maryam Boumezrag, MD: No financial relationships to disclose

Purpose: Spleen volume has been used as a predictor of adverse events in a variety of settings including assessing risk of liver failure following hepatectomy and predicting hepatocellular carcinoma (HCC) recurrence after treatment. The purpose of this study was to determine the relationship between spleen volume and portal pressure in cirrhotic patients undergoing TIPS.

Materials and Methods: A review of all patients who had undergone TIPS between January 2020 and April 2022 was performed. A total of 59 patients were identified. 19 patients were excluded due to presence of portal vein thrombosis and 40 patients remained for this study. Patients were stratified based on whether they presented for emergent TIPS due to active variceal bleeding or elective TIPS for nonemergent indications. Spleen volumes were determined by semi-automated segmentation on the most recent periprocedural imaging and was divided by body surface area (BSA). Patient characteristics, MELD scores, portal pressure were evaluated. Paired T-tests were used to compare the two groups.

Results: Amongst 40 patients who underwent TIPS, 20 presented emergently and 20 presented non-emergently. MELD scores and portal pressures were significantly higher in patients presenting for emergent TIPS (p< .05), with an average MELD of 24 in the emergent TIPS group compared to 11 in the elective TIPS group and an average portal pressure of 24 in the emergent TIPS group compared to 17 in the elective TIPS group. Assessment of spleen volumes demonstrated no difference between the two groups (p = 0.25). A weak correlation of 0.38 was noted between spleen size and portal pressure (95% CI –0.08-0.70).

Conclusion: There was no statistical difference in splenic volume between patients presenting for emergent TIPS compared to patients undergoing elective TIPS and a weak correlation between splenic volume and portal pressure. Given these findings, splenic volume may have limited prognostic value in this population. This needs to be validated in a larger population.