[Intrahepatic portasystemic shunt as a salvage treatment of uncontrolled hemorrhage caused by rupture of esophageal varices in patients with liver cirrhosis].
OBJECTIVE
Patients who continue to bleed despite standard treatment including sclerotherapy have a poor prognosis with a mortality up to 90%. TIPS has been used as salvage therapy for ruptured oesophageal varices refractory to all conventional treatments.


METHODS
During a period of 3 years, 65 cases of variceal rupture in cirrhotic patients were treated at our center and a salvage TIPS was performed in 15 patients (23%) for active uncontrolled hemorrhage despite standard medical and endoscopic treatment (Child A, 2; B, 1; C, 12). The procedure was technically successful in all cases and hemorrhage was controlled in 11/15 cases (73%).


RESULTS
Three patients died of persistent bleeding and liver failure; one case of moderate and persistant hemorrhage was controlled by transfusions until bleeding ceased. This patient was transplanted 3 months after TIPS and is alive 3.5 years later. Two patients had early recurrence of hemorrhage due to TIPS thrombosis. These 2 cases of thrombosis were deobstructed but both patients died of liver failure despite bleeding control. Overall, 7 patients died within 60 days of TIPS by hemorrhage and/or liver failure. One patient died of liver failure 7 months after TIPS following surgery for aortic aneurysm. None of the 8 survivors after 60 days had bleeding recurrence or encephalopathy. Actuarial survival was 42.7 +/- 14% at 1 and 2 years.


CONCLUSIONS
TIPS is currently the alternative of choice for persistant bleeding refractory to standard management. However despite control of hemorrhage, operative mortality remains high due to the underlying severe cirrhosis.
Azoulay
D
D
Centre hépato-biliaire, Hôpital Paul Brousse, Villejuif.
Castaing
D
D
Ichai
P
P
Saliba
F
F
Bismuth
H
H
D000328:Adult; D000368:Aged; D004630:Emergencies; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000401:mortality; D011446:Prospective Studies; D012422:Rupture, Spontaneous
Shunt intrahépatique porto-sushépatique de sauvetage pour hémorragie par rupture de varices oesophagiennes non contrôlée chez le cirrhotique.