CLINICAL OUTCOME 2 YEARS AFTER IMPLANTATION OF A TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT FOR RECURRENT VARICEAL BLEEDING

Objective: Implantation of a transjugular intrahepatic portosystemic s hunt (TIPS) is a relatively new therapy for variceal bleeding. The aim of this study was to assess clinical course 2 years after TIPS proced ure. Design: The study was designed as a prospective, uncontrolled coh ort study. Methods: Forty-six patients who underwent successful TIPS i mplantation were followed prospectively by clinical examinations, dupl ex sonography and portal venography. Mean follow-up in surviving patie nts was 24.1 +/- 9.0 months. Results: The cumulative rate of survival was 80.4% at 1 year and 70.2% at 2 years. The cumulative rebleeding ra te was 12.4% at 1 year and 21.3% at 2 years. The mortality rate of epi sodes of variceal rebleeding was 22.2%. Variceal rebleeding was associ ated with shunt abnormalities, and successful shunt revision resulted in control of the bleeding. The cumulative incidence of shunt stenosis or occlusion was 41.2% at 1 year and 54.9% at 2 years. Of those patie nts without shunt abnormalities after 1 year, 23.3% developed shunt st enosis or occlusion during the second year after TIPS procedure. Shunt revision was successful in 96.6% of cases. Secondary patency rate was 88.1% after 2 years. Conclusion: Successful TIPS implantation results in a low rate of morbidity and mortality from variceal rebleeding ove r 2 years. TIPS creation in combination with careful follow-up examina tions represents an effective long-term treatment of recurrent varicea l bleeding. Even in patients in whom no shunt abnormality is detected during the first year, routine duplex follow-up examinations should be continued at 3-month intervals.