TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS USING THE WALLSTENT PROSTHESIS - A FOLLOW-UP-STUDY

Purpose: The aim of the present study was to assess the efficacy of tr ansjugular intrahepatic portosystemic shunts (TIPS) in 45 patients wit h cirrhosis during a mean follow-up of 7 months. Methods: Forty-five c onsecutive patients treated by TIPS and who had been followed for at l east 6 months after TIPS or until death, were included. Mean follow-up was 7.2 +/- 5.0 months. Shunt patency was assessed at 1 week and 1 mo nth, then every 3 months after the procedure by Doppler US and angiogr aphy whenever needed. Results: Thirty-six patients had been stented fo r refractory bleeding from ruptured esophagogastric varices. Of these, 8 patients (22%) rebled, 7 of whom were treated by a second shunt. Ni ne patients were treated for refractory ascites. Three patients had re current ascites due to shunt obstruction. All were treated by a second shunt which occluded in 2 patients. As a whole, 14 (31.1%) patients d eveloped shunt obstruction within a mean of 120 +/- 136 days, 4 of who m remained asymptomatic. Other complications were septicemia by Staphy lococcus aureus in 1 patient, transient encephalopathy in 9 patients, and disseminated intravascular coagulation in 1 patient. Conclusion: T IPS appears to be a relatively safe and effective technique in treatin g complications of portal hypertension in patients with cirrhosis. Shu nt obstruction in 31% of our patients probably represents the most imp ortant limitation of this technique.