[Transjugular intrahepatic portasystemic shunt. A new therapeutic method in portal hypertension].
Over the last three years, 53 patients underwent transjugular portosystemic shunting (TIPS). 49 patients were treated successfully (92.5%). Procedure-related morbidity (intention to treat) was seen in 11 patients (20.8%): encephalopathy (n = 5), sepsis (n = 3), right heart failure (n = 2) and progressive liver failure (n = 1). 30-day mortality rate was 13.2% (7/53); five of these patients were in stage Child-Pugh C, one patient in stage B, and one patient had a known coronary heart disease. 30-day rebleeding rate was 6.1% (3/49), but all these patients could be retreated successfully by radiological methods (PTA, embolisation, thrombolysis). Angiographic follow-up (mean six months) of 35 patients detected 30 (85.7%) haemodynamic relevant obstructions (stenosis of stent: n = 4, stenosis of hepatic vein: n = 15, stenosis of stent and hepatic vein: n = 5, occlusion of TIPS-shunt: n = 6). Secondary patency rate following percutaneous reintervention was 91.3%. All rebleedings in the follow-up (n = 7) were treated successfully by TIPS-revision. Five out of 12 patients (41.7%) with refractory ascites were treated successfully by TIPS (complete resolution of ascites after three months: n = 4, significant reduction of ascites: n = 1). We conclude that transjugular portosystemic shunt is an effective way of treating portal hypertension, but there is a need to develop methods to prevent the high incidence of shunt stenosis.
Tesdal
I K
IK
Institut für Klinische Radiologie, Klinikum Mannheim der Universität, Heidelberg, Theodor-Kutzer-Ufer, Mannheim, Tyskland.
Jaschke
W
W
Adamus
R
R
Georgi
M
M
Filser
T
T
Holm
E
E
D000328:Adult; D000368:Aged; D000075202:Contraindications; D005069:Evaluation Studies as Topic; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D011859:Radiography; D015607:Stents
Transjugulaer intrahepatisk portosystemisk shunt. En ny behandlingsmetode ved portal hypertensjon.