EFFECTS OF TRANSJUGULAR INTRAHEPATIC PORTASYSTEMIC SHUNT (TIPS) ON SPLANCHNIC AND SYSTEMIC HEMODYNAMICS, AND HEPATIC-FUNCTION IN PATIENTS WITH PORTAL-HYPERTENSION - PRELIMINARY-RESULTS

The purpose of this study was to evaluate the short-term splanchnic an d systemic hemodynamics and hepatic function after TIPS creation. Fift een cirrhotics with portal hypertension underwent TIPS placement for t reatment of variceal hemorrhage, and extensive hemodynamic studies inc luding right heart catheterization, portal pressure measurement, hepat ic blood flow, and indocyanine green (ICG) clearance were performed be fore and 1 month after the procedure. Self-expandable metal stents (St recker 11 mm diameter) were placed in all cases. Portasystemic gradien t significantly diminished (18.3 +/- 4.2 vs 8 +/- 2.8; 54% +/- 18 mm H g) after the technique, mainly due to a decrease in portal pressure, a nd remained stable in the final study. Cardiac output and mean arteria l pressure increased (6.2 +/- 1.4 vs 8.2 +/- 1.8 liters/min, 80.1 +/- 10.1vs 91 +/- 11.2 mm Hg, respectively), and a decrease in systemic va scular resistance was registered (1018 +/- 211 vs 872 +/- 168 dyne/sec /cm(5)); the hepatic blood flow and ICG clearance also decreased signi ficantly (1.5 +/- 0.7 vs 0.68 +/- 0.2 liters/min, 0.4 +/- 0.2 vs 0.24 +/- 0.06 liters/min, respectively). There was an increase in the prelo ad at the final study, as evidenced by a marked increase in right atri al (3.1 +/- 1.6 vs 4.35 +/- 2.2 mm Hg, +15%, P < 0.05), pulmonary arte rial (12.2 +/- 2.4 vs 15.9 +/- 3.2 mm Hg, +31.8%, P < 0.001), and wedg e pulmonary arterial pressures (6.9 +/- 2.4 vs 9.8 +/- 3.1 mm Hg, +53% , P < 0.001). These results suggest that TIPS worsens the hyperdynamic syndrome associated to portal hypertension. Therefore, in patients wi th cardiac insufficiency, this procedure should be evaluated. TIPS als o decreases the hepatic blood flow, inducing a mild worsening in liver function.