[Clinical results and hemodynamic changes of portal venous system in transjugular intrahepatic portosystemic stent shunt]

Abstract

To study the clinical results and hemodynamic changes of portal venous system after TIPSS we created a transjugular intrahepatic portosystemic stent shunt in 140 patients with advanced cirrhosis and portal hypertension, meanwhile we used Doppler sonography, direct portography and measurement of portal pressure to assess the blood hemodynamic changes of portal venous system in 100 patients with TIPSS. The technical success rate of TIPSS was 94.62% in 130 patients except for 10 patients with portal venous occlusion. The complication rate related to TIPSS procedure was 4.62%. Slight encephalopathy was observed in 9.03% of patients with TIPSS. The early mortality within 30 days of treatment was 3.08%. Follow-up for 1 to 24 months showed that the stenosis or occlusion of shunt and variceal rebleeding or ascites were observed respectively in 12% and 9% of patients. Six percent of the patients with TIPSS died. The portal venous pressure and the inflow of collateral circulation remarkably decreased and the portal flow velocity increased by 2.4 times after TIPSS. The flow velocity of shunt and portal vein decreased by 11.39% and 20.14% respectively in the patients with shunt patency, while the flow velocity continued to decrease in the patients with shunt stenosis or occlusion during the follow-up. TIPSS is an effective method for treating the patients with portal hypertension due to cirrhosis. The observation of trends in the hemodynamic changes of portal venous and shunt can early diagnose and treat the shunt stenosis or occlusion.