title: Transjugular intrahepatic portosystemic shunt: where are we?
abstract: OBJECTIVE
  The purpose of this study was to evaluate the technical/hemodynamic success, complications, and biochemical/ hematologic consequences of transjugular intrahepatic portosystemic shunt (TIPS) created with 10-mm bare stents in our patients.
  
  
  METHODS
  Data of 27 cirrhotic patients (18 men and 9 women; mean age, 39.7±18.7 years) with a median MELD score 14 (range 7-31) treated with TIPS between January 2000 and August 2010 were evaluated retrospectively.
  
  
  RESULTS
  The indications were refractory bleeding varices in 48.2%, refractory ascites in 22.2%, and Budd-Chiari syndrome in 29.6% of the patients. Technical and hemodynamic success rates were 96.3% and 92.3%, respectively. Mean portosystemic pressure gradient decreased from 21.5±5.3 mm Hg to 9±2.7 mm Hg (p<0.05). The rate of primary stent patency was 76.9% 1 year after the procedure. No statistically significant difference in shunt dysfunction was found between the groups of patients treated for Budd-Chiari syndrome and other indications (p>0.05). One patient (3.7%) had shunt dysfunction due to thrombosis within 24 hours. New and/or worsening hepatic encephalopathy occurred in 34.6% of patients. Increased age (≥40 years) was significantly related to hepatic encephalopathy in both univariate and multivariate analyses (p<0.05). Thirty-day mortality rate and 1-year transplant-free survival rate were 0% and 80.7%, respectively.
  
  
  CONCLUSIONS
  Transjugular intrahepatic portosystemic shunt procedure is a safe treatment for many patients with cirrhosis, but post-procedure hepatic encephalopathy and shunt dysfunction are still problems. Especially, patient age should be taken into consideration in predicting hepatic encephalopathy risk.
authors.affiliation: Department of Gastroenterology, Başkent University Faculty of Medicine, Ankara, Turkey. reskanaltun@yahoo.com.
authors.forename: Reskan
authors.initials: R
authors.lastname: Altun
authors.forename: Emre
authors.initials: E
authors.lastname: Yıldırım
authors.forename: Serkan
authors.initials: S
authors.lastname: Ocal
authors.forename: Enver
authors.initials: E
authors.lastname: Akbaş
authors.forename: Ali
authors.initials: A
authors.lastname: Harman
authors.forename: Murat
authors.initials: M
authors.lastname: Kormaz
authors.forename: Haldun
authors.initials: H
authors.lastname: Selçuk
mesh_terms: D000328:Adult; D006502:Budd-Chiari Syndrome / Q000209:etiology / Q000601:surgery*; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome