[Transjugular intrahepatic portosystemic shunt (TIPS): indications and results after 22 months of experience].
December 1991 through November 1993, fifty-five patients underwent TIPS with the following indications: failed sclerotherapy or surgery (25 patients), bleeding from gastric varices (3 patients), patients waiting for liver transplantation (11 patients) and refractory ascites (9 patients). Seven patients were included in a randomized TIPS vs sclerotherapy trial. The average follow-up of living patients is 4.6 months (range: 1-16 months). The technical success rate was 100%. The portosystemic gradient decreased from 22 mmHg to 10.7 mmHg. After TIPS all patients were followed-up with endoscopic, angiographic and color Doppler examinations and underwent periodic clinical checks. Early (5-day) angiographic follow-up exams showed partial stent thrombosis in 5/32 cases (15.5%) and complete stent thrombosis in 3 cases (9.3%). Late angiographic follow-up exams (1-9 months) showed complete stent occlusion in 2 cases, stent stenosis in 8 cases and hepatic vein stenosis in 5 cases. At present, 37 patients are alive (67%); 5 patients have undergone liver transplantation (9%), and 13 patients died (24%)--3 within 48-72 hours after the procedure and 10 in 1-8 months. Five patients had recurrent bleeding (9%). Ascites was reduced or disappeared in 8/9 cases. Early clinical complications occurred in 12% of cases and were treated with medical therapy. Within one year, signs of encephalopathy developed in 13 patients (23%) and were successfully treated with medical therapy.
Rossi
P
P
III Cattedra, Università degli Studi di Roma, La Sapienza.
Maccioni
F
F
Salvatori
F M
FM
Bezzi
M
M
Gandini
R
R
Broglia
L
L
Ingianna
D
D
D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery*; D008099:Liver; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000379:methods*
Derivazione porto-sistemica intraepatica transgiugulare (TIPS): indicazioni e risultati dopo 22 mesi di esperienza.