[Transjugular portacaval shunt. Preliminary experience]

Abstract

Transjugular intrahepatic portosystemic stent-shunt (TIPS) is a new technique in interventional radiology. This procedure is based on the creation of an intrahepatic channel between a main branch of the portal vein and an hepatic vein. A metallic stent is implanted to keep this shunt patent. From July 1990 to March 1992, 28 out of 32 patients with a history of gastric or esophageal variceal rebleeding, were treated by TIPS and followed for up to 20 months (mean 9.36 +/- 5.42). According to the Child Pugh's classification, 9 patients had class A cirrhosis, 17 class B and 6 class C. TIPS led to reduction of the portal pressure gradient by 57% and improvement of the portal blood flow by 250%. Early complications were: one technique-related death due to a medial stent implantation on the portal bifurcation (massive extrahepatic bleeding), other cases consisted of hemobilias (3 patients), intra-abdominal bleeding (1 patient) and gastrointestinal bleedings (4 patients). All of the complications except the deat were spontaneously reversed after withdrawal of Heparin. Follow-up showed a considerable improvement of ascites, seen in 55% of the patients with 100% reduction or disappearance after 3 months. Duplex-sonography follow-up found shunt stenosis in 43% of the patients, allowing preventive redilatation to restore patency of the shunt. Variceal rebleeding occurred in 20% of cases. These results remain interesting with regard to the high risk of bleeding in the patients of this preliminary study.(ABSTRACT TRUNCATED AT 250 WORDS)