THE NATURAL-HISTORY OF PORTAL-HYPERTENSION AFTER TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS

Background & Aims: The effects of transjugular intrahepatic portosyste mic shunt (TIPS) on portal hemodynamics, esophageal and gastric varice s, and hepatic function have not been fully defined. The aim of this s tudy was to define prospectively the effects of TIPS on portal pressur es and flow, variceal resolution, and hepatic function. Methods: Press ure and flow measurements were made by angiography and Doppler sonogra phy, respectively. Varices were assessed by endoscopy and angiography. Liver functions were evaluated by a battery of tests. Results: In 100 consecutive subjects, mean portosystemic gradient decreased from 24 t o 11 mm Hg (means) (P < 0.001) after TIPS. Recurrent portal hypertensi on caused by stent thrombosis (n = 5), stent retraction (n = 2), and s tent stenosis (n = 51) occurred at 6 months but, by year 5, was not pr esent in survivors (n = 0 of 8). Fundic gastric varices failed to reso lve in 6 of 12 cases. Systemic venous pressures of >15 mm Hg, stent dy sfunction, and continued alcoholism were risk factors for recurrent he morrhage. Angiography was superior to endoscopy, which was superior to Doppler sonography for detection of recurrent portal hypertension. Pr ogressive liver failure occurred in 8 patients. Conclusions: Recurrent portal hypertension caused by stent stenosis occurs commonly in the f irst 2 years after TIPS. Fundic gastric varices often fail to disappea r after TIPS. The effects of TIPS on liver function are unpredictable.