Background and Aims: The Enhanced Liver Fibrosis (ELF) test, combining hyaluronic acid (HA), tissue inhibitor of metalloproteinases-1 (TIMP-1) and procollagen III N-terminal propeptide (PIIINP), reflects hepatic extracellular matrix turnover and fibrogenesis and is validated as a prognostic biomarker in advanced chronic liver disease (ACLD). We evaluated the prognostic value and dynamics of ELF in ACLD patients undergoing transjugular intrahepatic portosystemic shunt (TIPS).Methods: Patients undergoing covered TIPS at Vienna General Hospital included in the prospective AUTIPS registry (NCT: NCT03409263; 01/2017-03/2025) with available ELF values pre- and post-TIPS were recorded. ELF and its components were measured at baseline pre-TIPS(BL), 1-month post-TIPS (M1), and at 12 months or the last available long-term measurement (LM). Laboratory, hemodynamic, and clinical data were recorded. Paired or non-parametric tests assessed temporal changes; correlations and outcome associations were analyzed by Spearman and Fine-Gray competing risk regression.Results: Among 80 included patients (median age 57 years, 65% male, 54% alcohol-related liver disease), median BL ELF was 11.7 (11.0-12.8). ELF showed an early increase at M1 after TIPS, followed by a return to baseline [BL vs M1 vs LM= 11.7 (11.0-12.8) vs 12.2 (11.3-13.2) vs 11.9 (11.0-12.8); p< 0.001]. Both HA and PIIINP also increased at M1 and returned to BL values, [HA BL vs M1 vs LM: 322.2 (172.8-521.0) vs 368.5 (218.3-727.0) vs 313.7 ((177.3-618.8)) ng x mL-1; p<0.001; PIIINP BL vs M1 vs LM: 19.3 (12.6-29.7) vs 28.3 (20.7-47.3) vs 23.9 (16.4-35.3) ng x mL-1; p<0.001]. Interestingly, however, TIMP-1 showed a constant decrease at M1 and a further significant decrease at LM: 444.4 (313.4-586.5) vs M1: 404.6 (297.8-497.4) vs LM: 366 (279.5-510.5) ng x mL-1; p<0.001]. Changes in ELF positively correlated with Model of End Stage Liver Disease (MELD) score (ρ=0.303, p=0.024) and liver stiffness measurement (LSM) (ρ=0.413, p=0.043).In competing risks regression analysis (adjusted for age and MELD) BL ELF was not independently linked to post-TIPS survival (sHR=0.99, 95% CI 0.45-2.20, p=0.980). Interestingly, ELF at M1 (sHR=1.62, 95% CI 1.13 - 2.33, p= 0.009) was independently linked to mortality. Correlation analyses showed that TIMP-1 at M1 moderately correlated with interleukin-6 (ρ=0.51, p<0.001) and C reactive protein (ρ=0.44, p<0.001). Specifically, persisting high TIMP-1 (asHR=1.51, 95% CI 1.03-2.21, p=0.035) was linked to mortality. M1 HA values (x 10-3 for clarity) were associated with post-TIPS encephalopathy (asHR=1.04, 95% CI 1.01-1.08, p=0.011).Conclusions: In ACLD patients TIPS, ELF score and its components show a distinct dynamic post-TIPS. An early (M1) increase in HA after TIPS may reflect reduced sinusoidal clearance and was linked to an increased risk of post-TIPS HE. A progressive decline in TIMP-1 was linked to improved inflammation post-TIPS and associated with favorable outcomes.

The use of controlled-expansion transjugular intrahepatic portosystemic shunt (CX-TIPS) effectively controls portal hypertension (PH)-related complications while reducing risks related to fully expanded stents. We evaluated the effectiveness of CX-TIPS in a large Viennese patient cohort. We assessed the number of patients evaluated for CX-TIPS placement by interdisciplinary discussion at the Medical University of Vienna and included all patients from the prospective AUTIPS registry undergoing CX-TIPS placement between June 2018 – December 2024. After clinical and laboratory characterization at baseline, patients were followed up for clinical events. Overall, 200 patients underwent interdisciplinary evaluation for CX-TIPS. In 62.5

We evaluated the dynamics of spontaneous portosystemic shunts (SPSS) after transjugular intrahepatic portosystemic shunt (TIPS). Ninety patients with covered TIPS placement and contrast-enhanced CT scans before and after TIPS were included. Total SPSS area and total shunt area (including TIPS) were assessed. Median SPSS area (67.2-15.7 mm2; p < 0.001) decreased after TIPS, while total shunt area remained unchanged (67.2-75.8 mm2; p = 0.170). Relative SPSS area decrease was an independent protective factor for mortality (asHR: 0.19; 95% CI: 0.04-0.88; p = 0.034). In conclusion, SPSS decrease after TIPS and relative SPSS area change is independently linked to survival, while total shunt area remains unaltered.

The Billroth IV consensus was developed during a consensus meeting of the Austrian Society of Gastroenterology and Hepatology (ÖGGH) and the Austrian Society of Interventional Radiology (ÖGIR) held on the 26th of November 2022 in Vienna. Based on international recommendations and considering recent landmark studies, the Billroth IV consensus provides guidance regarding the diagnosis and management of portal hypertension in advanced chronic liver disease.

Patients with cirrhosis often develop portal hypertension-associated splenomegaly and hypersplenism, potentially causing severe cytopenia. Systematic assessment on the impact of transjugular intrahepatic portosystemic shunt (TIPS) implantation on platelet count (PLT), hemoglobin (Hb), and white blood cell count (WBC). Patients with cirrhosis undergoing covered TIPS implantation were retrospectively included. Patients with malignancies or hematologic disorders were excluded. Hematology lab work was recorded at baseline (pre-TIPS) and at regular intervals after TIPS. One hundred ninety-two patients (male: 72.4

Background and Aims Guidelines suggest implantating a transjugular intrahepatic portosystemic shunt (TIPS) in patients with recurrent/refractory ascites who are at risk for hepatorenal syndrome (HRS). However, data on the course and risk of HRS after TIPS are limited.

Background: To compare open repair (OR) with EVAR for the management of ruptured infrarenal abdominal aortic aneurysms (RAAA) in a cohort study over a time period of 15 years with inverse probability of treatment weights. Material and methods: From 2000/01 through 2015/12 136 patients were treated for RAAA, 98 (72.1%) underwent OR, 38 (27.9%) were treated with EVAR. Thirty-day and long-term mortality (survival) were analyzed in this IRB-approved retrospective cohort study. Treatment modalities were compared using inverse probability of treatment weights to adjust for imbalances in demographic data and risk factors. Results: EVAR patients were older (75.11 +/- 7.17 vs 69.79 +/- 10.24; p=0.001). There was no statistical difference in gender, hypertension, COPD, CAD, or diabetes. GFR was significantly higher in OR patients (71.4 +/- 31.09 vs. 53.68 +/- 25.73). Postoperative dialysis was required more frequently in EVAR patients: 11% vs. 2% (p = 0.099). In the OR group, adjusted cumulative survival was 70.4% (61.1, 81.1) at 30 days, 47.0% (37.1, 59.6) at one year and 38.3% (28.6, 51.3) at 5 years. In the EVAR group the corresponding numbers were 77.0% (67.7, 87.5), 67.5% (57.0, 80.0) and 41.7% (30.4, 57.4), respectively. Conclusion: There is evidence for EVAR patients exhibiting a benefit in one-year survival, while patients treated with OR may have more favorable long-term survival given they survive for at least one year. Herein we provide a statistically rigorous comparison of OR and EVAR in short and long-term outcomes with up to 15 years of follow-up.