necrosis factor (T IF), and interferon-y increased withinthree hours, and IL-lO within 18 hours. Antibody titersincreased significantly in all patients. Objective re­sponses were demonstrated in combination withchemotherapy, including one patient who was refrac­tory to both Onyx-015 and 5-fluorouracil as singleagents.

CONCLUSION: Hepatic alterial infusion of attenuatedOnyx-015 adenovirus was well-tolerated in doses result­ing in infection, replication, and antitumor activity.

Risk Fac:tors for liver Abscess FormationFoUowing Hepatic Chemocmbolization.\ft. Kim, niuel i~JI o/Penn ;yll'auiCl, Phi/adelphia,

PA, :A. T W lark. R.A. Baum • M.e. Soulen

PURPO 'E: To as e s the frequency and ri k factorsfor liver absc;; <lfter h pati ·hemoemhoJi7.ation.

MA7ERIALS AND METHOD: Retr spective analy is

of 39 chemoembolizations in 157 patiem . All pa­tiems reeei ed intravenous cephazolin 19 andmetronidazole 500mg before embolization, thencephazolin 500mg IV q hand m tronida70le ')OOO1gN q 12h until dis harge, th n five day of oral amox­icilJinidavulonate or ciprofl Xl! in 500 mg BID.ChemoemboJization was p >rformed with ci platin,do 'ombicin, mitomy in- " iodized oil, and P A in alob~lr distribution. The association between abscessformation and ri k faclor wa determined withFisher's exa t te t and expres ed a an odds ratio.

RES 'ITS: Liver < b ce occurred in 7/157 patient( .5 %) follOWing 8/397 procedure - (2.0 %) at am an of 19 ± 7 days (range, l3-30d'l after chem em­bolization. ix patients required percutaneousdra nage for 35 ± 29 days (range, J2-75 day . The7th patient required drainage for life due (0 a non­healing bilial fistula. No patients were neutropeni .Or ani ms in Itlded Enteroco 'cus (3 , Elllerobacrer(2, itrobacter, Pseudomona ,E. ali, and trepsp cie (J ea h); infection W(l, polymicrobial in 3ca e . Tumor type included 3- of 2£1 neuroendocrinepaltents (12.5%, odd ralio 4.6, 9';% cr 0.96-22.1,1'=.17 , duodenal sarcoma (3 of 14 Gf sarcomas,_Hi\ odds ratio 9.5, 95%0 1.9-4 .8, 1'=.016), andpan reati adena ar inama (I of 2 patients). 'ix ofthe 7 patients had a Whipple pro dure prior to

hemoembolizalion. Only one patient with ::I previ­ou.!> hi tory of a Whipple pro edure did not de" lopan lcpatic abscess. In the absence of a bilio nlencanastomosis, an abscess occurred in only 1/150 pa­tient 0.7% among 383 1'1' cedure (0.3%). Theod s ratio for liver ab C $' among patients with abiliocntcric an, ·tomosis wa' 94 (95% 1,5 -16000;P < .0001).

1:47 pm

FEATURED ABSTRACTCommentator: Marshall Hicks, MD

Abstract No. 16

CONCLUSION- Prior bilioenteric anastomosis is themajor determinant of liver abscess after hepaticchemoembolization. Our prophylaxis regimen failedto prevent abscess formation in these patients.

Scientific Session 3Portal Hypertension / TIPSModerators: Ziv Haskal, MD

jae-Hyung Park, MD

Sunday, March 4, 200112:30 pm-2:00 pm

12:30 pm Abstract No. 17

Causes of Death and Predictors of Survival afterTIPS: A Multivariate Analysis.

j.M. Laberge, UCSp' San Francisco, CA, USA •

R.K Kerlan • M. W Wilson • Y Lu • RL Gordon

PURPOSE: To determine risk factors for death afterTIPS. Although TIPS is an effeC[ive means of controllingvariceal hemorrhage, overall survival is not improvedby TIPS. As many as 2QO!o die within 30 days and 5QO!o

die within 1-2 years of the procedure. Child's Class andAPACHE II score are useful predictors of acute mortalitybut other factors related to early and late survival havenot been well delineated.

MATERIALS AND MFIHODS: We analyzed survival datain 90 patients treated by TIPS for variceal bleeding whowere followed prospectively for a maximum of 9 years.Causes or death were identified and cumulative survivalwas calculated using the Kaplan-Meier method. Cox­proportional hazards multivariate regression was per­formed to determine predictors of overall mortality.Variables included age, sex, etiology of bleeding, en­cephalopathy, aSCites, biochemical parameters (biliru­bin, albumin, prothrombin lime, creatinine and plateletcount).

R'ESULTS' During the follow-up period, 49 patients(54%) died, 26 (29%) underwent liver transplantation, 2(2.2%) were lost to follow-up and 13 (14%) survived fora mean of 7.5 years. Fourteen patients died within 30days due to multi-system organ failure (n=lO), malig­nancy (n=2), myocardial infarction (n=1) or varicealbleeding (n=1). Late death (>30days) was due to liverfailure (n=20), malignancy (n=4), non- variceal bleeding(n=4), variceal bleeding (n=3) and other causes (n=4).Overall, variceal bleeding was the cause of death inonly 4 of 49 patients (8%). Cumulative survival was 57%at 1 year, 320/0 at 5 years and 22% at 8 years. Significantindependent risk factors included serum creatinine(hazard =5.12, p=.OOI), etiology of liver disease (hazard=2.48, p=.006), and ChiJd's-Pugh score (hazard = 1.36,p=.OOl). S7

A Newly Designed ePTFE Covered Stentgraft forTIPS: Results of a Multicenter Feasibility Study.j. Lammer, University Vienna, Vienna, Austria·

H. Rousseau • P Rossi • G. Richter • M. Cejna •Z}. Has/eal

CONCLUSION Variceal bleeding is an uncommoncause of death after TIPS. Child's Pugh score is a usefulpredictor of cumulative survival and is a better prog­nostic indicator than any of its component parameters.Elevated serum creatinine and etiology of liver diseasedue to viml and alcoholic hepatitis are also strong riskfactors.

12:52 pm Abstract No. 19

12:41 pm Abstract No. 18

PURPOSE: The primary objective of the prospectiveclinical study was to evaluate the safety and efficacy at6 months of a new stentgraft for TIPS.

PURPOSE- To evaluate the performance of a jYfFE-cov­ered TIPS endoprothesis in a swine-model.

CONCLUSION· The TIPS stentgraft can be implantedsafely. Clinical and hemodynamic and venographic pa­tency was high at 6 months. Coverage of the hepaticvein outflow up to the rvc seems to be mandatory.

MATERIALS AND METHODS: The study was designedfor to pigs. For TIPS creation a PTFE-covered TIPS-en­doprothesis (Viatorr, Gore et Ass) was used. The ani­mals were divided into two groups. Group-2 receivedintraluminal irradiation of 18 Gy with lrridium-192.

The Effects of EndoluminaJ Irradiation on theHealing Response of PTFE-Covered TransjugularIntrahepatic Portosystemic Shunt Prosthesis.K.A. Hausegge,~ University Hospital Graz, LKH, Graz,

Austria • HR. Portugalle,- • j. Tauss • P Schedlbauer• H. Deutschmann • H. Stranzl, et al.

Abstract No. 201:03 pm

MATERIALS A/IlD METIlODS: The TIPS stentgraf[ is anewly designed ePTFE covered nitinol endoprosthesiswhich can be inserted through a 10 F sheath. Tn 4 cen­ters 38 patients (mean age S4 y, range 23-73y) were en­rolled. The clinical indications were variceal bleeding(n=16), refractory ascites (n=l1), both (n=l1), due to al­coholic cirrhosis (n=19), hepatitis (n=5), both (n=6) andother fibrotic diseases (n=8). Patients were in Childclass A (32%), B (SO%), and C (18%). The stentgraft wasimplanted for a de novo TIPS in 26 patients and duringrevision of a reobstr1.1cted TIPS in 12 patients. Follow-upwas performed by clinical exam and CDUS at 1,3,6 and12 months, venography and portosystemic pressure gra­dient measurement (PSG) was performed at 6 months.

RESULTS: In 38 patients 48 stentgrafts were inserted suc­cessfully. PSG was reduced from a mean value of 21mmHg to 7 mmHg. The 30d complications were deathin 2 (S.2%), encephalopathy in 3 (7.8%), hemoperi­toneum in 1 (2.6%) and left portal vein thrombosis in 2(S.2%) patients. Clinical success at 30d was achieved in36 patients (9S%). Return of ascites (device patent, PSG19 mmHg) and rebleeding (device patent, PSG 22mmHg) were observed in 2 patients. The mean follow­up was 6.3 months (4.5-12 mo). At 6 months (92% fol­low-up) hemodynamic patency «15mmHg PSG) was88%, venographic patency 100%. Four hepatic veinstenoses proximal to stentgraft were observed.

RESULTS: The mean age of ]2 female and 9 male pa­tients was S6 years (37-74 y). All patients were eitherChild's Class B (8) or C (13). There was 100% technicalsuccess with two patients (9%) requiring acute revision.Mean follow-up was 223 days 0-1641 d). Twenty fourpercent (S/21) died within 30 days of TIPS, 9% (2/21)were transplanted within thirty days and 67% (14/21)survived beyond 30 days. Of the 30-clay survivors, SO%(7/14) died by the end of the study. Some data wereunavailable in 2 patients. Clinical response was com­

plete in 63% (12/19), partial in 11% (2/19) and none in26% (S/19). Radiographic response was complete in 30%(6120), partial in SO% (10/20) and none in 20% (4/20).A lower serum BUN and a greater decrease in portosys­temic gradient (PSG) independently correlated withcomplete clinical response (p=0.048 and p=0.046, re­spectively). Several other parameters (lower serum cre­atinine, higher serum albumin, and larger stent size)showed a trend toward complete clinical improvement.

l\!IETIlODS: Between 6/95 and 8/00, 21 patients re­ceived TIPS for hepatic hydrothorax. All failed thora­centesis and conservative medical managemenL. Aprospectively collected TIPS database, supplementedby medical records, was reviewed retrospectively. Clin­ical and radiographic response to TIPS was recorded ascomplete (resolution of symptoms/effusion), pm'fial

(improvement in symptoms/effusion) or none. Panernsin the data were examined with Chi-square and logisticregression analysis.

PURPOSE Hepatic hydrothorax, though rare, is a debil­itating complication of portal hypertension. We soughtto evaluate the efficacy of 'nps placement in treatingpatients with hepatic hydrothorax and to determine anypatient or procedural factors that correlate with treat­ment response.

Safety and Efficacy of Transjugular IntrahepaticPortosystemic Shunt for Treatment of HepaticHydrothorax.E.B. Spencer, Mallinckrodt Institute ojRadiology, St.

Louis, 1140, USA • D. T Coben • M.D. Darcy

CONCLUSIOIY' Despite the overall poor prognosis inthis patient group, the majority experienced improve­ment in clinical symptoms following TIPS with a vari­able reduction in the quantity of pleural fluid. A lower

BUN and a greater decrease in PSG predict better c1ini-88 cal outcome.

CONCLUSION: TIPS is a safe and effective treatment forvariceal bleeding and/or intractable ascites. Preproce­dural portal vein pressure gradient and Child class arethe significant factors for the primary and secondary pa­tency. However, Child class is the only significant prog­nostic factor for long-term survival.

Long-term Results in Patients after TransjugularIntrahepatic Portosystemic Shunts: An OutcomeStudy.Z. W. Zhuang, Dartmouth-Hitchcock Medical Center,

Lebanon, NH, USA • M.A. Bellmann • Gj. Teng •

R.FJeffery • DR. Langdon

follow-up period, encephalopathy was newly devel­oped or aggravated in 18 patients (23.1%). Primary andsecondary patency rates were 60.oo!o and 80.4% at 1year, 44.6% and 70.3% at 2 years. In the multivariateevaluation, preprocedural portal vein pressure gradientand Child class were the significant factors for the pri­mary and secondary patency. Among many factors,Child class and protaJ pressure data were the significantprognostic factors for long-term survival. However, onlyChild class was significant in multivariate analysis(p=O.OOOI, RR 5.5)

Abstract No. 221:25 pm

CONCLUSION: The endoprothesis used in the study re­vealed good TIPS patency in a swine-model without ra­diation. Application of 18 Gy intraluminal irradiationwith Irridium-192 seems to impare the natural healingprocess.

Group-l erved as the control group without irradiation.Angiographic evaluation of the TIPS was performedevery two weeks, animals of both groups were sacri­ficed every two weeks and gross specimen, histological

RESULTS: TIPS insertion was successful in all animals.Two pigs died early due to procedural complications.One animal (group-l) developed encephalopathy anddied one week too early (seventh week), one animal(group-2) scheduled for 6-week survival showed shuntocclusion after two weeks and was killed thereafter.Observation period was 8 weeks at maximum. Allgroup-l animals showed a patent TIPS. In group-2 oneshunt occluded after two weeks, in another animal a60% mid-shunt stenosis was observed at 2-week con­trol. In group-l all implants were firmly adhered to theliver "issue. The luminal surface gradually became cov­ered by fibrous connective tissue which was covered byendothelium. In group-2 the implants were partially ad­hered or non-adhered to the liver and large thrombiwere seen in two implants. Intimal necrosis in the hostvessel was seen in one animal.

PURPOSE: In order to assess the long-term results andprognostic factors of transjugular intrahepatic portosys­temie shunt (TIPS) performed in 94 cases during last 10years in an Asian center.

Long·term Results and Prognostic Factors inTransjugular Intrahepatic Portosystemic Shunt.JR. Park, Seoul National University Hospital, Seoul,

South Korea • Cj. Yoon • j. W': Chung • j.H. Cho •Sj. Sbin

RESULTS: TIPS was successfully performed in all pa­tients except one (98.9%). The pOrtosystemic pressuregradient decreased from 23.0 mmHg to 12.0 mmHg.Variceal bleeding and/or ascites were controlled in 78patients (83%). Thirty-day mortality was 16%. During

MATERIALS AND METHODS: One hundred and threepatients who underwent TIPS were followed for amean of 20.10 25.58 months (range 1 day to 92months). Variolls statistical methods were used to ana­lyze long-term survival, shunt patency, and the correla­tion with Child-Pugh classification and with indicationsfor TIPS. The SF-36 was employed to assess quality oflife over time.

PURPOSE: To determine the long-term survival, long­term shunt patency, and long-term quality of life inpatents after placement of transjugular intrahepatic por­tosystemic shunts (TIPS).

RESULTS: The cumulative survival rate was 68%, 60%,50%, 41% and 41% at 1-, 2-, 3-, 4- and 5-years, respec­tively. There was a significant increase in cumulativeulvival rate comparing Child-Pugh class AlB to cla C

patients (P<O.Ol), as well as for patients with the origi­nal indication of variceal bleeding vs. those with refrac­tory ascites or hydrothorax (P<O.Ol). There was no sig­nificant difference between Child A and Child B(P=0.29). The cumulative primary patency rate was 50%,34%, 21%, 13%, and 13% at 1-, 2-, 3-, 4- and 5-years, re­spectively. The cumulative primary assisted patencyrate, however, was 8oo!o, 61%, 46%, 42%, and 36% andthe cumulative secondary patency rate was 85%, 64%,55%, 55%, and 55% at 1-, 2-, 3-, 4- and 5-years. Meanfollow-up time in the 33 patients who completed qual­ity of life questionnaires with one follow-up was 17.46months. The post-TIPS scores of quality of life in all 9 of 89

Abstract No. 211:14pm

MATERIALS AND METHODS: TIPS was performed in 94patients for variceal bleeding (n=92) or intractable as­cites (n=2) from June 1991 to May 2000. The long-termresults including efficacy, complication and patencyrates during follow-up period (up to 84 months, mean18.9 months) were evaluated. The patency rates werecompared between subgroups of different Child,-sclassifications, of different stents, and of different punc­ture routes. The long-term survival rate was obtainedwith Kaplan-Meier method. The prognostic factors wereevaluated according to the age, cau e of liver cirrhosis,Child,-s classification, pre- and post-TIPS portal pres­sures and pressure gradients, technical differences, etc.

transplanted livers. The Quick-core needle yieldsgood specimen adequacy and, in our experience,usually necessitates only ·three specimens for patho­logic diagnosis.

the health categories of the SF-36 were higher than be­fore the procedure with statistically significant improve­ment in four. The second follow-up was completed in21 patients, Both post-TIPS scores were higher than pre­TIPS, and five categories were further improved at the2nd surveillance at mean 15 months after the first, whilefour categories showed minor worsening. 1:47 pm Abstract No. 24

CONCLUSION TIPS has positive efficacy both for con­trolling bleeding or ascites and for improving the qual­ity of life.

Peritoneal Port for Refractory Ascites.D.I. Rosenblum, The Cleveland Clinic Foundation,

Cleveland, OR, USA • TM. Boelen • D.C. Markowitz •

D.A. Powell • IS. Newman • KD. Mullen

CONCLUSION In comparison to the traditional per­cutaneous liver biopsy technique, the transjugularliver biopsy technique is a safe and efficaciousmethod to obtain adequate biopsy specimens in

PURPOSE: To evaluate the safety and efficacy of tran­sjugular liver biopsy in patients with liver transplants.Comparison to the percutaneous biopsy technique isalso performed.

Tr3nsjugular Liver Biopsy in Patients with liverTransplants.BH. Lin, The University ofChicago Hospitals, Chicago,

IL, USA • T Van Ha • E. Zeikus • B. Fimaki •

I Lorenz • I Leef

RESULTS: Technical success rate was 98% (41/42) forthe transjugular technique and 94% (49/52) for the per­cutaneous method. An average of 3.1 specimens percase was obtained using the transjugular Quick-corebiopsy needle. 98% (40/41) of transjugular and 94%(46/49) of percutaneous biopsies yielded adequate tis­sue for pathologic diagnosis. Most patients who under­went transjugular biopsy had coagulation abnormalitiesor ascites. Renal tissue was found in the specimen inone transjugular biopsy; one patient had delayed bleed­ing after transjugular biopsy. Two patients had pro­longed bleeding (not requiring transfusion) and threeexperienced persistent fevers after percutaneous liverbiopsy.

Scientific Session 4NeurointerventionsModerator: Jj. "Buddy" Conners III, MD

Tim Malisch, MD

CONCLUSION Peritoneal port placement is a promisingalternative that provides fast access to the peritonealcavity and is well accepted by our patient population.The true rate of infectious complications awaits furtherstudy. Ultimately, peritoneal port placement may be auseful palliative measure in patients with cirrhotic re­fractory ascites as well as malignant ascites.

RESULTS: Peritoneal ports functioned well in all 5 pa­tients. During the next 4-50 weeks, up to 11 L of asciteswere drained weekly. Studies of the peritoneal fluidwere not routinely performed for uneventful paracente­sis. All complications were recorded and treated appro­priately. Two cases of spontaneous bacterial peritonitis(SBP) occurred more than six weeks after port place­ment. Two deaths occurred; one was related to SBP thatwent untreated by family directive and the other deathwas unrelated to the port. Catheter failure due to ob­struction or fracture did not occur in any patient. Peri­toneal port drainage was sllccessfully performed onweekly bases in two patients by visiting nursing serv­ices at home.

PURPOSE: To determine the feasibility of peritonealports for clinical management of patients with cirrhoticrefractory ascites.

Sunday, March 4, 20013:15 pm·4:45 pm

MATERIALS AND METHODS: From December 31, 1997to March 17, 1999, five modified venous access ports(8F MRI Implantable Port, Bard Access Systems, SaltLake City, UT) were placed in'five patients for the pur­pose of frequent outpatient paracenteses. All patientshad refractory ascites secondary to hepatic dysfunc­tion, and three had prior episodes of hepatic en­cephalopathy. Retrospective review and telephone in­terviews were used to assess performance ofperitoneal ports.

Abstract No. 231:36 pm

MATERIALS AND METHODS: Retrospective review of100 consecutive transjugular liver biopsies during athree year period was performed. Age ranged from 22to 66. All biopsies were obtained with a semiautomatedQuick-core biopsy needle. FOlty-twO (42%) biopsieswere performed in transplanted livers. Biopsy indica­tions, coagulation profiles, number of specimens ob­tained, complications, and pathology results were tabu­lated. Database review of the same period alsoidentified 100 consecutive cases of image-guided percu­taneous liver biopsy performed for diffuse liver diseaseor transplant-related indications. Fifty-two (52%) caseswere in transplanted livers; and 35 (35%) in pediatricpatients (ages: 11 months to 18 years). The results werecompared to the transjugular technique.

810