Clinical outcome two years after implantation of a transjugular intrahepatic portosystemic shunt for recurrent variceal bleeding.
OBJECTIVE
Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is a relatively new therapy for variceal bleeding. The aim of this study was to assess clinical course 2 years after TIPS procedure.


METHODS
The study was designed as a prospective, uncontrolled cohort study.


METHODS
Forty-six patients who underwent successful TIPS implantation were followed prospectively by clinical examinations, duplex sonography and portal venography. Mean follow-up in surviving patients was 24.1 +/- 9.0 months.


RESULTS
The cumulative rate of survival was 80.4% at 1 year and 70.2% at 2 years. The cumulative rebleeding rate was 12.4% at 1 year and 21.3% at 2 years. The mortality rate of episodes of variceal rebleeding was 22.2%. Variceal rebleeding was associated with shunt abnormalities, and successful shunt revision resulted in control of the bleeding. The cumulative incidence of shunt stenosis or occlusion was 41.2% at 1 year and 54.9% at 2 years. Of those patients without shunt abnormalities after 1 year, 23.3% developed shunt stenosis or occlusion during the second year after TIPS procedure. Shunt revision was successful in 96.6% of cases. Secondary patency rate was 88.1% after 2 years.


CONCLUSIONS
Successful TIPS implantation results in a low rate of morbidity and mortality from variceal rebleeding over 2 years. TIPS creation in combination with careful follow-up examinations represents an effective long-term treatment of recurrent variceal bleeding. Even in patients in whom no shunt abnormality is detected during the first year, routine duplex follow-up examinations should be continued at 3-month intervals.
Gschwantler
M
M
Fourth Department of Internal Medicine, KA Rudolfstiftung, Vienna, Austria.
Gebauer
A
A
Rohrmoser
M
M
Schrutka-Kölbl
C
C
Vavrik
J
J
Brownstone
E
E
Tscholakoff
D
D
Weiss
W
W
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D015996:Survival Rate