The role of transjugular intrahepatic portosystemic shunts in the management of patients with end-stage liver disease.
BACKGROUND
Transjugular intrahepatic portosystemic shunt (TIPS) has been reported to successfully treat complications of portal hypertension; however, not all reports have been favorable.


METHODS
Forty patients underwent 41 attempts to place a TIPS. All patients but 1 had a Wallstent placed.


RESULTS
Thirty-nine procedures (95%) were successful. Thirty-one patients were treated for gastrointestinal bleeding, and 9 for refractory ascites. The average fall in portal pressure was 13.7 +/- 0.9 mm Hg. Major postprocedure complications included 4 deaths. Minor problems included liver capsular perforation, fever, self-limited bleeding, and a pseudoaneurysm. Follow-up evaluation revealed that by 5 months, 50% of the shunts developed a portal-venous-to-right-atrial pressure gradient requiring balloon dilatation or a new stent. The 1-year actuarial patient survival was 72%. Eighteen patients were candidates for orthotopic liver transplantation (OLT) and 5 have been transplanted.


CONCLUSIONS
TIPS may be best used for stabilization, prior to OLT or as a temporizing measure prior to elective shunt surgery.
Forster
J
J
Department of Surgery, University of Kansas Medical Center, Kansas City 66160-7309.
Delcore
R
R
Payne
K M
KM
Siegel
E L
EL
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000401:mortality; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D015607:Stents; D015996:Survival Rate