Transjugular intrahepatic portosystemic shunt: midterm clinical and angiographic follow-up.
OBJECTIVE
To determine the impact of Child class and indication for transjugular intrahepatic portosystemic shunt (TIPS) placement on patient survival and reintervention rate.


METHODS
Metal stents were used to successfully create single shunts in 63 patients during a 3-year period. Angioplasty and repeated stent placement were used to maintain shunt patency, and patients were followed up clinically and angiographically. Statistical analysis of survival and patency was performed with Kaplan-Meier product-limit survival functions. A Karnofsky performance status score was derived for each follow-up encounter.


RESULTS
Early and late mortalities varied with Child class and procedure indications. Thirty-day mortality was 19% overall (12 of 63 patients) and was 33% for Child class C patients (10 of 30 patients). Thirty-day mortality was 31% (four of 13 patients) for patients with ascites and 16% (eight of 50 patients) for those with bleeding. Reintervention was required in 20 of 33 patients and was not predictable on the basis of Child class.


CONCLUSIONS
Child class and indication for procedures are significant predictors of survival but not of the need for reintervention. Ninety-day survivors had uniformly good performance status.
Fillmore
D J
DJ
Department of Radiology, University of Utah Medical Center, Salt Lake City 84132, USA.
Miller
F J
FJ
Fox
L F
LF
Disario
J A
JA
Tietze
C C
CC
D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006501:Hepatic Encephalopathy / Q000453:epidemiology; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011859:Radiography; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors