[Transjugular placement of an intrahepatic portosystemic shunt as current treatment for complications of portal hypertension]

Abstract

Objective: To analyse the results in 31 patients who underwent transjugular intrahepatic portosystemic shunting (TIPS).

Design: Retrospective study.

Setting: University Hospital Rotterdam-Dijkzigt, Rotterdam, the Netherlands.

Method: Data of all patients who underwent a TIPS procedure from February 1992 to September 1994 were analysed. Indications for TIPS included recurrent variceal bleedings and refractory ascites. TIPS was performed under general anaesthesia. After TIPS heparin was given during one week.

Results: TIPS creation succeeded in 29 out of 31 patients. The mean portosystemic pressure gradient after TIPS was 9.6 mmHg. After 1.5 years the cumulative percentage of recurrent variceal bleeding was 44. The quantity of ascites decreased in 73% of the patients. During recatheterisation shunt dysfunction was seen in 16 out of 21 patients. Mortality was 13% within 30 days. The actuarial percentage of patients who died was 43 after 1.5 years. Mortality depended on Child-Pugh classification.

Conclusion: TIPS is a new, safe and fast treatment for patients with complications of portal hypertension. The number of recurrent variceal bleedings was substantial. Intensive control examinations are imperative to discern shunt dysfunction. Long-term survival rates and morbidity depend on the seriousness of the pre-existing liver disease.