[Effects of percutaneous intrahepatic portosystemic shunt on splanchnic and systemic hemodynamics in patients with portal hypertension].
Transjugular intrahepatic portosystemic shunt (TIPS) is a calibrated shunt directed at reducing the portal pressure gradient with a low incidence of hepatic encephalopathy and deterioration of hepatocellular function. The present study investigated the effects of TIPS on splanchnic and systemic hemodynamics on liver function and on the development of encephalopathy. A group of 30 patients treated with TIPS were included in the study: 26 patients with hepatic cirrhosis for an hemorrhagic episode by esophageal varices not controlled by medical treatment and sclerotherapy and in 4 cases with the Budd-Chiari syndrome for ascites refractory to medical treatment. Before, at 24 hours and 2 months after TIPS, the portal pressure gradient, cardiopulmonary pressure and cardiac output, blood flow of the azygos vein, and hepatic clearance of indocyanine green as indexes of liver function were determined. TIPS significantly decreased the portal pressures gradient and azygos blood flow. This was associated with a significant increase in cardiac output and a significant decrease in peripheral vascular resistance and hepatic clearance of indocyanine green. Portal flow deviated by TIPS was greater in the 9 patients (30%) who developed hepatic encephalopathy during follow up. In conclusion, TIPS effectively reduces portal hypertension. Nonetheless, it is associated with an increase in hyperdynamic circulation, a high incidence of encephalopathy and a deterioration in liver function.
François
E
E
Laboratorio de Hemodinámica Hepática, Hospital Clínic i Provincial, Barcelona.
García-Pagán
J C
JC
Bru
C
C
Feu
F
F
Gilabert
R
R
Escorsell
A
A
Bosch
J
J
Rodés
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001201:Ascites / Q000601:surgery; D006502:Budd-Chiari Syndrome / Q000601:surgery; D004932:Esophageal and Gastric Varices / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery; D006439:Hemodynamics; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008103:Liver Cirrhosis / Q000601:surgery; D008111:Liver Function Tests; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D013152:Splanchnic Circulation; D013997:Time Factors
Efectos de la derivación portosistémica percutánea intrahepática sobre la hemodinámica esplácnica y sistémica en pacientes con hipertensión portal.