[Transjugular intrahepatic portosystemic stent shunts]

Abstract

We studied the clinical and procedural results of transjugular intrahepatic portosystemic stent shunts (TIPSS) procedures in 16 patients, of whom 13 were male, 3 female, with mean age of 48 years (range 24-66). All patients had cirrhosis with portal hypertension and varices. Twelve patients had recurrent bleeding for gastroesophageal varices. The results showed that shunts were successful in 14 of the 16 patients, and that no death was due to the procedure. Portal vein pressure was reduced from 3.98 +/- 0.24 kPa before shunting to 2.40 +/- 0.16 kPa after shunting. Doppler ultrasound revealed that the maximum blood flow velocity in the main portal vein increased from 14.0 +/- 4.5 cm/s to 48.0 +/- 16.5 cm/s. The mean follow-up time in the successful cases was 4.5 months (range, 2-7.5). The shunt patency was determined with color Doppler ultrasound in 13 patients, and occlusion of the tract was found in one. Mild ascites resolved in 4 patients; varices disappeared in 7 patients and abated in 6. No bleeding or encephalopathy was noted during the follow-up. The results suggested that TIPSS is an safe and effective method for portal decompression in the treatment of variceal hemorrhage, and that the key to TIPSS is understanding of the 3-dimensional relationships between hepatic and portal veins. To achieve an adequate shunt, we recommend that stent with 12 mm in diameter should be used.