[Transjugular intrahepatic portacaval shunt. Preliminary results].
Transjugular implantation of a metallic prosthesis between main portal branch and a hepatic vein is a new intrahepatic portosystemic shunt method to treat portal hypertension. Forty-nine cirrhotic patients with portal hypertension were treated using this technique. The success rate of implantation was 94%. Mortality due to the procedure was 2%. Early complications decreased with the operator's learning curve consisting of bleeding (20%): digestive hemorrhage (n = 5; 12%), hemobilia (n = 4; 8%), which ceased after withdrawal of post-operative heparin. Early thrombosis following shunt implantation occurred in 13% of the patients. Shunt implantation resulted in a 53 +/- 16% decrease in the portocaval pressure gradient (21 +/- 5 to 10 +/- 4 mmHg). Shunts were performed in 45 patients to prevent a recurrence of variceal bleeding. Follow-up of 41 patients showed 12.2% with variceal rebleeding and 16 patients (39%) with a stenosis requiring a redilation. Ascites improved in 95% of the patients and hepatic encephalopathy occurred in 17%. One year survival was 85%. Controlled studies are needed to determine the indications of this new treatment for ascites and bleeding.
Perarnau
J M
JM
Service de Médecine Interne B et d'Hépato-Gastroentérologie, Centre Hospitalier Régional, Hôpital Notre-Dame-de-Bon-Secours, Metz.
Raabe
J J
JJ
Schwing
D
D
Rucin
B
B
Monchovet
S
S
Rössle
M
M
Arbogast
J
J
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000209:etiology / Q000601:surgery*; D006502:Budd-Chiari Syndrome / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008103:Liver Cirrhosis / Q000150:complications; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications; D011859:Radiography; D012008:Recurrence; D014465:Ultrasonics
Anastomose porto-cave intra-hépatique par voie transjugulaire. Résultats préliminaires.