Clinical events after transjugular intrahepatic portosystemic shunt: correlation with hemodynamic findings.
OBJECTIVE
Transjugular intrahepatic portosystemic shunt (TIPS) procedures are increasingly being used, but the relationship between the hemodynamic effects of TIPS and the clinical events on follow-up remains undefined. Hence, we have investigated the hemodynamic correlations of portal hypertension-related events after a TIPS procedure.


METHODS
Prospective follow-up of 122 cirrhotic patients who had a TIPS procedure performed because of variceal hemorrhage was conducted.


RESULTS
The portacaval pressure gradient (PPG) significantly decreased after the TIPS procedure (from 19.7 +/- 4.6 to 8.6 +/- 2.7 mm Hg; P > 0.001), but increased thereafter and at rebleeding (n = 25) was > 12 mm Hg in all patients (18.4 +/- 4.6 mm Hg). Twenty-six patients developed ascites; the PPG (measured in 19) was always > 12 mm Hg. Increasing the PPG to > 12 mm Hg occurred very frequently (83% at 1 year). Within 1 year, 77% of patients underwent balloon angioplasty or restenting. However, 80% had again a PPG of > 12 mm Hg 1 year after reintervention. Hepatic encephalopathy developed in 31% of patients at 1 year; 21 of 23 patients had a PPG of < 12 mm Hg.


CONCLUSIONS
Total protection from the risk of recurrent complications of portal hypertension after a TIPS procedure requires that the PPG be decreased and maintained < 12 mm Hg. However, reintervention will be required in most patients within 1 year and again the second year. On the other hand, such portal decompression is associated with an increased risk of hepatic encephalopathy.
Casado
M
M
Department of Medicine, Hospital Clìnic i Provincial, Universitat de Barcelona.
Bosch
J
J
García-Pagán
J C
JC
Bru
C
C
Bañares
R
R
Bandi
J C
JC
Escorsell
A
A
Rodríguez-Láiz
J M
JM
Gilabert
R
R
Feu
F
F
Schorlemer
C
C
Echenagusia
A
A
Rodés
J
J
D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology; D001794:Blood Pressure / Q000502:physiology; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006470:Hemorrhage / Q000209:etiology / Q000601:surgery; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011184:Postoperative Period; D011446:Prospective Studies; D012008:Recurrence; D014684:Venae Cavae / Q000503:physiopathology