Forster J, Delcore R, Payne K M, Siegel E L
Department of Surgery, University of Kansas Medical Center, Kansas City 66160-7309.
Am J Surg. 1994 Dec;168(6):592-6; discussion 596-7.
Transjugular intrahepatic portosystemic shunt (TIPS) has been reported to successfully treat complications of portal hypertension; however, not all reports have been favorable.
Forty patients underwent 41 attempts to place a TIPS. All patients but 1 had a Wallstent placed.
Thirty-nine procedures (95%) were successful. Thirty-one patients were treated for gastrointestinal bleeding, and 9 for refractory ascites. The average fall in portal pressure was 13.7 +/- 0.9 mm Hg. Major postprocedure complications included 4 deaths. Minor problems included liver capsular perforation, fever, self-limited bleeding, and a pseudoaneurysm. Follow-up evaluation revealed that by 5 months, 50% of the shunts developed a portal-venous-to-right-atrial pressure gradient requiring balloon dilatation or a new stent. The 1-year actuarial patient survival was 72%. Eighteen patients were candidates for orthotopic liver transplantation (OLT) and 5 have been transplanted.
TIPS may be best used for stabilization, prior to OLT or as a temporizing measure prior to elective shunt surgery.
