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Creation of transjugular intrahepatic portosystemic shunts with the wallstent endoprosthesis: results in 100 patients.
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1993
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VaricesHepatologyEndovascular TechniqueTips CreationPortal Vein PressureWallstent EndoprosthesisGastroenterologyVascular SurgerySurgeryShunt StenosisEndovascular ManagementVascular AccessLiver DiseaseLiver TransplantationMedicineAnesthesiology
TIPS was created in 100 patients, mainly for variceal bleeding (94), with additional indications of ascites, hepatorenal syndrome, and preoperative portal decompression. TIPS was successfully completed in 96 of 100 patients, reducing portal pressure from 34.5 to 24.5 mm Hg, controlling acute variceal bleeding in 29 of 30 cases, and yielding a 48‑patient survival average of 7.6 months, while 10 patients experienced bleeding recurrence, 15 had shunt stenosis or occlusion (with patency restored in 8 of 9 occlusions), and 17 developed new or worsened encephalopathy, leading the authors to conclude that TIPS effectively lowers portal pressure and controls variceal bleeding, especially in refractory acute cases and pre‑transplant chronic bleeding.
One hundred patients underwent transjugular intrahepatic portosystemic shunt (TIPS) creation for variceal bleeding (n = 94), intractable ascites (n = 3), hepatorenal syndrome (n = 2), and preoperative portal decompression (n = 1). Shunts were completed in 96 patients. Portal vein pressure was reduced from 34.5 mm Hg +/- 7.6 (standard deviation) to 24.5 mm Hg +/- 6.2; the residual portal vein-hepatic vein gradient was 10.4 mm Hg +/- 0.9. Acute variceal bleeding was controlled in 29 of 30 patients. Of the 96 patients who underwent successful TIPS creation, 26 have died and 22 have undergone liver transplantation; the remaining 48 patients have survived an average of 7.6 months. Variceal bleeding recurred in 10 patients. Fifteen patients developed shunt stenosis (n = 6) or occlusion (n = 9). Patency was reestablished in eight of the nine occluded shunts. Seventeen patients developed new or worsened encephalopathy. The authors conclude that TIPS creation is an effective and reliable means of lowering portal pressure and controlling variceal bleeding, particularly in patients with acute variceal bleeding unresponsive to sclerotherapy and patients with chronic variceal bleeding before liver transplantation.