PORTAL-HYPERTENSION AND PERCUTANEOUS TRAN SJUGULAR PORTOSYSTEMIC STENT-SHUNTS (TIPSS)

This paper reports 1) the historic development of TIPSS, the transjugu lar intrahepatic portosystemic stent shunt from experimental evaluatio n to clinical realization. 2) The evolution of the intrumental techniq ue during a period of 6 years of clinical applications is described in detail. 3) Results based on 204 consecutive procedures are demonstrat ed: e.g. the early technical success defined as successful completion of the procedure and 30-day survival was 95%; the clinical success def ined as technically successful procedure and no rebleeding during the first 30 days was 83%, the 30-day mortality rate was 6.3%; the 30-day encephalopathy rate was 14.1%; the one-year re-bleeding rate was 11%; the one-year survival rate was 74%, the 3-year survival rate was 41%. 4) Problems of the TIPSS procedure are discussed including a 3-months re-stenosis rate of 46% and a cumulative one-year re-stenosis rate of 84% which requires correction by interventional procedures such as shu nt dilatation or additional vascular stent placement. 5) Limitations a nd indications of TIPSS are elucidated based on hemodynamic and functi onal aspects of liver cirrhosis.