A RETROSPECTIVE STUDY OF THE EFFICACY OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS

Transjugular intrahepatic portosystemic shunts (TIPS) are being used i ncreasingly for complications of portal hypertension, including active and recurrent variceal hemorrhage and intractable ascites, as well as for portal decompression in patients awaiting orthotopic liver transp lantation. We reviewed the initial 2-year experience with TIPS at Loui siana State University Medical Center - Shreveport and Willis-Knighton Medical Center, Shreveport, Louisiana, which involved 31 patients. Cl inical findings (with some patients having more than one finding) reve aled that 16 per cent (five) of the patients had active hemorrhage; 61 per cent (19), multiple episodes of (recurrent) variceal hemorrhage; and 48 per cent (15), ascites. The mean follow-up period was 6.2 month s, with a patient mortality of 13 per cent. Results showed that in 87 per cent (27 of 31) of patients the TIPS procedure was successfully pl aced. There was 100 per cent control of active variceal hemorrhage (fi ve patients) and ascites (12 patients; excludes three patients who die d). Rebleeding occurred in 18 per cent (four of 22) of patients, all r elated to stenosis or occlusion of the TIPS. The overall incidence of occlusion and stenosis was 11 per cent and 22 per cent, respectively. Seventy-seven per cent (seven of nine) of the patients experiencing th e latter complications underwent successful angioplasty or revision of their TIPS. The results of our experience indicate that TIPS placemen t can be performed successfully with low procedural morbidity. The pro cedure is effective in controlling active variceal hemorrhage refracto ry to endoscopic sclerotherapy. The use of TIPS may be particularly be neficial for patients who are either awaiting liver transplantation or poor candidates for surgical shunt procedures. TIPS may not be a long -term solution for patients with portal hypertension, given the curren t rates of occlusion and stenosis.