[Hemodynamics, liver function and clinical follow-up after TIPS].
In 126 patients with liver cirrhosis treated electively with transjugular intrahepatic portosystemic stent shunt (TIPS) to prevent variceal rebleeding, the portosystemic pressure gradient decreased by 60%. In spite of this incomplete effect the risk for variceal rebleeding was still under 20% after 2 years. Only 1 patient died of variceal rebleeding. Shunt insufficiency occurred in 50%, mainly during the first year, but shunt function was restored in nearly all cases by radiologic intervention, i.e., redilatation or implantation of an additional stent. During the follow-up of 16 +/- 9 months, 21 patients (17%) died, one-third of them from progressive liver failure aggravated in 4 cases by severe drinking. De novo hepatic encephalopathy was observed in 10%, especially in older patients and patients with impaired liver function before TIPS. In such patients it is recommended that the shunt be dilated to 0.8 cm at most, and the TIPS procedure can be combined with transjugular embolization of the varices. The advantages of TIPS over both endoscopic sclerotherapy and drug treatment must be clarified in randomized studies, which have already been initiated in several centers.
Haag
K
K
Radiologische Universitätsklinik, Freiburg.
Ochs
A
A
Deibert
P
P
Siegerstetter
V
V
Hauenstein
K H
KH
Berger
E
E
Gerok
W
W
Langer
M
M
Rössle
M
M
D002404:Catheterization / Q000295:instrumentation*; D002423:Cause of Death; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology*; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007601:Jugular Veins; D008099:Liver / Q000503:physiopathology*; D008111:Liver Function Tests / Q000145:classification; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology; D011169:Portal Vein / Q000601:surgery; D011170:Portasystemic Shunt, Surgical / Q000295:instrumentation*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology*; D012008:Recurrence; D015607:Stents; D015996:Survival Rate
Hämodynamik, Leberfunktion und klinischer Verlauf nach TIPS.