Incidence of shunt occlusion or stenosis following transjugular intrahepatic portosystemic shunt placement.
OBJECTIVE
Transjugular intrahepatic portosystemic shunt (TIPS) placement has been used for the treatment of recurrent variceal hemorrhage. The 1-year incidence of shunt stenosis or occlusion after TIPS placement was prospectively assessed, and the accuracy of Doppler ultrasonography to predict TIPS stenosis was evaluated.


METHODS
Twenty-two patients with recurrent variceal hemorrhage were selected for TIPS placement between April 1991 and May 1992. Preoperative and postoperative evaluation included clinical assessment, upper gastrointestinal endoscopy, portal angiography with pressure measurements, and Doppler ultrasonography. Follow-up was performed at 3 and 12 months post-TIPS and when patients developed recurrent bleeding.


RESULTS
Twenty-one of 22 patients (Child-Pugh class A-1, B-11, C-9) had successful TIPS placement. Seventeen of 21 patients have completed follow-up for at least 12 months. Of these 17 patients, 2 of 17 (12%) developed TIPS occlusion, 7 of 17 (41%) developed shunt stenosis, and 8 of 17 (47%) showed no stenosis on follow-up angiography. Doppler ultrasonographic assessment of the TIPS predicted shunt stenosis or occlusion with 100% sensitivity, 98% specificity, and 90% positive predictive value.


CONCLUSIONS
Shunt occlusion or stenosis develops frequently within 12 months after TIPS placement, and Doppler ultrasonography is accurate in the noninvasive assessment of shunt stenosis. TIPS placement without careful follow-up and shunt revision cannot be considered a long-term treatment of variceal hemorrhage.
Lind
C D
CD
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Malisch
T W
TW
Chong
W K
WK
Richards
W O
WO
Pinson
C W
CW
Meranze
S G
SG
Mazer
M
M
D000328:Adult; D000368:Aged; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology* / Q000209:etiology*; D006470:Hemorrhage / Q000628:therapy; D006503:Hepatic Veins / Q000503:physiopathology* / Q000648:ultrastructure; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000648:ultrastructure; D008107:Liver Diseases / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology* / Q000648:ultrastructure; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects*; D011446:Prospective Studies; D013997:Time Factors