title: Transjugular intrahepatic portosystemic shunt (TIPS); review of initial experience at Aga Khan University Hospital.
abstract: OBJECTIVE
  To retrospectively assess the therapeutic effectiveness and safety of transjugular intrahepafic portosystemic shunt (TIPS) in patients with portal hypertension related complications.
  
  
  METHODS
  Over a period of 7.5 years 19 patients (10 males and 9 females, age range 25-69 years) were referred for TIPS at our radiology department. Thirteen patients suffered from liver cirrhosis while 6 had Budd Chiari syndrome. All patients were evaluated with colour doppler ultrasonography and cross sectional imaging. Shunt procedures were performed under sedation or general anaesthesia through internal jugular approach. Metallic self expandable uncovered stents were placed in 15 patients and covered stent in 1 patient. Follow up of patency was evaluated with ultrasound in majority and by venography in some patients. Safety of the procedure and clinical outcome were analyzed.
  
  
  RESULTS
  Indications of procedure included variceal bleeding (n=8), ascites (n=4), ascites and bleeding (n=1) and Budd-Chiari syndrome (n=6). Technical success rate was 84.21%. Complication rate was 10.53%. Three days mortality was 15.79%. Mean primary shunt patency was 306.62 +/- 533 days. During follow-up stent occlusion occurred in 5 patients (31.25%). Four of these patients underwent successful reintervention. Recurrence of symptoms occurred in 68.75% patients.
  
  
  CONCLUSIONS
  TIPS is useful for management of complications of portal hypertension that are refractory to pharmacological and endoscopic treatment, however shunt stenosis or occlusion may cause recurrence of symptoms. Repeated interventions are often required to maintain shunt patency.
authors.affiliation: Radiology Department, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Rana Shoaib
authors.initials: RS
authors.lastname: Hamid
authors.lastname: Tanveer-ul-haq
authors.forename: Muhammad
authors.initials: M
authors.lastname: Azeemuddin
authors.forename: Zafar
authors.initials: Z
authors.lastname: Sajjad
authors.forename: Ishtiaq
authors.initials: I
authors.lastname: Chishti
authors.forename: Basit
authors.initials: B
authors.lastname: Salam
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology; D006502:Budd-Chiari Syndrome / Q000150:complications / Q000601:surgery*; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006785:Hospitals, University; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color