VARICEAL HEMORRHAGE - EFFICACY OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS CREATED WITH STRECKER STENTS

PURPOSE: To evaluate the efficacy of transjugular intrahepatic portosy stemic shunts (TIPS) in treatment of variceal hemorrhage. MATERIALS AN D METHODS: Forty-five patients with cirrhosis underwent TIPS placement for treatment of acute (n = 12) or recurrent (n = 33) variceal hemorr hage. Shunts were created with Strecker stents. RESULTS: Shunts were e stablished by deployment of stents in 42 patients. The portosystemic p ressure gradient decreased from an average of 20.4 mm Hg +/- 5.4 to 9. 2 mm Hg +/- 4.1. Complications included hepatic failure (n = 1), acute shunt thrombosis (n = 2), right jugular vein thrombosis (n = 1), bact eremia (n = 1), and stent misplacement (n = 1). Acute bleeding was con trolled in 12 patients. The 30-day mortality rate was 2%; four other p atients have since died. During follow-up (mean, 8.9 months), variceal bleeding recurred in six patients. Hepatic encephalopathy developed i n six patients. Shunt stenosis or occlusion requiring further interven tion occurred in 20 patients. CONCLUSION: TIPS are safe and effective in treatment of variceal hemorrhage; however, secondary interventions are often required to preserve shunt function.