Abstract No. 130 ▪ FEATURED ABSTRACT Comparative Study of Percutaneous Transhepatic Variceal Embolization versus Transjugular Intrahepatic Portosystemic Shunt in Controlling Emergent Variceal Hemorrhage

Transjugular intrahepatic portosystemic shunt (TIPS) is considered the standard of care in patients with emergent variceal bleeding. TIPS procedures can be complicated by difficult anatomy, supply access, and operator experience which can result in prolonged procedure times. Percutaneous transhepatic variceal embolization (PTVE) may be considered in emergent cases or when there is a contraindication for TIPS. This study is designed to compare the technical success, rebleeding, and survival rate of PTVE versus TIPs in controlling emergent variceal bleeding. In this single-center retrospective study, all patients who underwent PTVE or TIPS to control emergent variceal bleeding during 2002-2023 were included. Emergent cases were defined as requiring pressors or massive transfusion, hemodynamic instability, or shock. Technical success was compared between the two groups. The primary outcome was rebleeding rates at 5 days, 1 month, 6 months, and 1 year. The survival rates at 1 month, 3 months, and 6 months were compared between the two groups. Statistical significance was accepted at p< 0.05. Among 333 patients during the study period, 10 and 40 patients underwent an emergent PTVE and TIPS, respectively. The average ages were 50±14 and 54±16 years for PTVE and TIPS groups (p=0.5). The male:female ratio was 27:13 and 7:3 for PTVE and TIPS groups (p =0.88). Average MELD scores were not significantly different between PTVE and TIPS groups (16.0±7.2 and 18.6±9.5, p=0.441). The technical success was 100% in both groups (p=1.0). The rebleeding rates at 5-day (33.3% vs 25%), 1 month (44.4% vs 37.5%) 6 months (44.4% vs 40%) and >1 year (44.4% vs 45%) were not significantly different between PTVE and TIPS groups, respectively (p=0.8). There was no significant difference in survival rate between the two groups at 1 month (56% vs 62%, p=0.7), 3 months (43% vs 53%, p=0.7), and 6 months (33% vs 50%, p=0.6) for PTVE and TIPS, respectively. PTVE is an efficient alternative treatment to TIPS in controlling emergent cases of variceal hemorrhage with similar rebleeding rates and survival outcomes. PTVE may be considered to control emergent life-threatening variceal hemorrhages where time can be a significant factor or when TIPS is contraindicated.