title: Transjugular intrahepatic portosystemic shunt with the Strecker stent for control of refractory acute and chronic variceal bleeding.
abstract: BACKGROUND
  We wanted to assess prospectively the safety, efficacy, and applicability of transjugular intrahepatic portosystemic shunt (TIPS) with the Strecker stent, focusing mainly on clinical and hemodynamic medium- and long-term follow-up.
  
  
  METHODS
  Fifty-two patients reached an indication to perform a TIPS, in an emergency or after refractory variceal bleeding. It was completed in 50 of them. All presented with cirrhosis (Child C = 15, B = 23, A = 12). The prosthesis was a Strecker stent. During the follow-up, clinical, biochemical, endoscopic, ultrasound, and pressure measurement studies were performed at 1, 3, 6, 12 months. Mean follow-up was 13.5 + or - 7.8 months.
  
  
  RESULTS
  Portal pressure decreased from 32.3 + or - 8.1 (mean + or - standard deviation) to 22.3 + or - 6.7 mm Hg and portocaval gradient from 21 +/- 5.2 to 8.7 +/- 3.9 mm Hg (average, 56 + or - 16%). Shunt dysfunction was diagnosed when the portocaval gradient was >12 mm Hg (20 patients). Eleven patients (22%) presented with variceal rebleeding because of shunt dysfunction. The probability of remaining free of bleeding was 78%, 74%, and 68% at 6, 12, and 24 months, respectively. Actuarial survival rate was 91% and 86% after 12 and 18 months, respectively.
  
  
  CONCLUSIONS
  TIPS with the Strecker stent is a safe alternative for variceal bleeding. Shunt dysfunction is frequent and increases the rebleeding rate, requiring a close follow-up with pressure measurements. Randomized trials comparing stents and other alternatives are needed to fully address the role of this procedure.
authors.affiliation: Hepatogastroenterology Service and Interventional Radiology Section, Gregorio Maranon General University Hospital, Madrid, Spain.
authors.forename: R B
authors.initials: RB
authors.lastname: Canizares
authors.forename: J M
authors.initials: JM
authors.lastname: Rodriguez-Laiz
authors.forename: M C
authors.initials: MC
authors.lastname: Martin
authors.forename: A E
authors.initials: AE
authors.lastname: Belda
authors.forename: F C
authors.initials: FC
authors.lastname: Alonso
authors.forename: F P
authors.initials: FP
authors.lastname: Roldan
authors.forename: L S
authors.initials: LS
authors.lastname: Castro
authors.forename: E C
authors.initials: EC
authors.lastname: Arregui
authors.forename: G C
authors.initials: GC
authors.lastname: Ricote
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents