title: Multicenter investigation of the role of transjugular intrahepatic portosystemic shunt in management of portal hypertension.
abstract: OBJECTIVE
  To determine the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) placement, a prospective multicenter trial was undertaken.
  
  
  METHODS
  In eight institutions, 96 patients underwent TIPS placement after failed sclero-therapy (Child-Pugh class A [n = 24], class B [n = 38], and class C [n = 34]), with follow-up for 6 months (with ultrasonography and angiography and clinical and laboratory studies).
  
  
  RESULTS
  TIPS placement was successful in all patients (mean initial portosystemic pressure gradient, 22.8 mm Hg + 6.7 [standard deviation]; mean decrease after placement, 12.8 mm Hg + 5.2), with variceal embolization in 25 patients. Complications included liver capsule puncture (n = 12), hepatic artery puncture (n = 3), main portal vein puncture (n = 1), and increased encephalopathy (n = 28). The 30-day mortality rate was 0% for patients with Child class A disease, 18% for class B, and 40% for class C. At 6 months, primary patency was 88% and assisted patency was 94%.
  
  
  CONCLUSIONS
  The risk associated with TIPS placement is reasonable, and it is an effective procedure for the treatment of portal hypertension.
authors.affiliation: Department of Radiology, University of Washington Medical Center, Seattle 98195, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Coldwell
authors.forename: E J
authors.initials: EJ
authors.lastname: Ring
authors.forename: C R
authors.initials: CR
authors.lastname: Rees
authors.forename: G
authors.initials: G
authors.lastname: Zemel
authors.forename: M D
authors.initials: MD
authors.lastname: Darcy
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Haskal
authors.forename: M A
authors.initials: MA
authors.lastname: McKusick
authors.forename: A J
authors.initials: AJ
authors.lastname: Greenfield
mesh_terms: D016022:Case-Control Studies; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D015911:Sclerotherapy; D013997:Time Factors; D017211:Treatment Failure