LONG-TERM RESULTS OF TIPSS USING THE PALM AZSTENT

Since our first clinically successful TIPSS procedure in 1988 numerous steps to improve the safety and methodology have helped to increase t he technical and clinical success while the rate of complications coul d be significantly reduced. In our series of more than 200 patients th e technical success rate is more than 95 % and the early clinical succ ess rate (< 30 days after TIPSS) 89 %, respectively. Early shunt occlu sion was found in 1.5 % of our patients. 3 months after TIPSS, however , transjugular portography reveals significant shunt stenosis in 46 % needing either shunt re-dilatation or additional stent placement. This relatively high rate of re-intervention is being significantly reduce d during the further follow-up with a frequency of 17 % at a 6 month i nterval and 6 % at a 12 month interval, respectively. The need for rei ntervention is strongly associated with liver function and the patient s' coagulation status: Child's A patients needed re-intervention subst antially more often than those in stage B or C at each given follow-up interval. The decreasing need for re-intervention over time appears t o be associated with the formation of an endothelial cell layer on the surface of the shunt tract.