TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC S HUNT (TIPS) AND HEMORRHAGICEMERGENCIES IN CIRRHOTIC-PATIENTS

From March 1992 to March 1994, 26 patients underwent Transjugular Intr ahepatic Portosystemic Shunt (TIPS) for emergency treatment of varicea l bleeding. Patients were all cirrhotic, with a mean age 55 +/- 13 yrs , Child's score was A = 4, B = 10, C = 12. TIPS was performed in case of failure or impossibility to obtain hemostasis after endoscopic and/ or medical treatment. Hemostasis was sucessful in all cases of TIPS, a nd the portocaval gradient was lowered from 19 to 9 mmHg. Early compli cations occurred in 30% of cases. They consisted of: spontaneously reg ressive hemobilia (15%) and shunt thrombosis (15%) (3:4 were repermeab ilized). Early mortality accounted for 15% of patients in the whole gr oup and 25% in Child C'patients. During follow-up (m = 8 +/- 6 m), onl y one patient rebled, de novo hepatic encephalopathy occurred in 15% o f patients always regressive in response to Lactulose therapy. One yea r mortality rate was 57%. A comparison between TIPS and other emergenc y hemostasis methods: endoscopic sclerotherapy, surgical portocaval sh unt and esophageal transsection was performed on the early mortality r ate according to the percentage of Child C'patients in the various ser ies. TIPS is better than other methods in series with a low percentage of Child C'patients. TIPS should be proposed: - in case of failure of endoscopic methods; - for patients waiting for liver transplantation; - when portal vein patency is compromised by thrombosis. This last in dication implies that portal patency must be confirmed with angiograph y or better by with duplex sonography once primary hemostasis of varic eal bleeding has been completed.