TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT WITH THE STRECKER STENTFOR CONTROL OF REFRACTORY ACUTE AND CHRONIC VARICEAL BLEEDING - RESULTS IN 50 PATIENTS

Background: We wanted to assess prospectively the safety, efficacy, an d applicability of transjugular intrahepatic portosystemic shunt (TIPS ) with the Strecker stent, focusing mainly on clinical and hemodynamic medium- and long-term follow-up. Methods: Fifty-two patients reached an indication to perform a TIPS, in an emergency or after refractory v ariceal bleeding. It was completed in 50 of them. All presented with c irrhosis (Child C = 15, B = 23, A = 12). The prosthesis was a Strecker stent. During the follow-up, clinical, biochemical, endoscopic, ultra sound, and pressure measurement studies were performed at 1, 3, 6, 12 months. Mean follow-up was 13.5 +/- 7.8 months. Results: Portal pressu re decreased from 32.3 +/- 8.1 (mean +/- standard deviation) to 22.3 /- 6.7 mm Hg and portocaval gradient from 21 +/- 5.2 to 8.7 +/- 3.9 mm Hg (average, 56 +/- 16%). Shunt dysfunction was diagnosed when the po rtocaval gradient was > 12 mm Hg (20 patients). Eleven patients (22%) presented with variceal rebleeding because of shunt dysfunction. The p robability of remaining free of bleeding was 78%, 74%, and 68% at 6, 1 2, and 24 months, respectively. Actuarial survival rate was 91% and 86 % after 12 and 18 months, respectively. Conclusion: TIPS with the Stre cker stent is a safe alternative for variceal bleeding. Shunt dysfunct ion is frequent and increases the rebleeding rate, requiring a close f ollow-up with pressure measurements. Randomized trials comparing stent s and other alternatives are needed to fully address the role of this procedure.