The role of transjugular intrahepatic portosystemic shunts in the management of patients with end-stage liver disease.

BACKGROUND

Transjugular intrahepatic portosystemic shunt (TIPS) has been reported to successfully treat complications of portal hypertension; however, not all reports have been favorable.

METHODS

Forty patients underwent 41 attempts to place a TIPS. All patients but 1 had a Wallstent placed.

RESULTS

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.

CONCLUSIONS

TIPS may be best used for stabilization, prior to OLT or as a temporizing measure prior to elective shunt surgery.