Multicenter investigation of the role of transjugular intrahepatic portosystemic shunt in management of portal hypertension.
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.
Coldwell
D M
DM
Department of Radiology, University of Washington Medical Center, Seattle 98195, USA.
Ring
E J
EJ
Rees
C R
CR
Zemel
G
G
Darcy
M D
MD
Haskal
Z J
ZJ
McKusick
M A
MA
Greenfield
A J
AJ
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