CLINICAL-EXPERIENCES WITH THE TRANSJUGULA R INTRAHEPATIC PORTACAVAL-SHUNT (TIPS)

Twenty-five patients with liver cirrhosis and portal hypertension were admitted for creation of a transjugular intrahepatic portosystemic sh unt (TIPS). The procedure was successful in 22 patients (technical suc cess 88 %). The mean portal pressure gradient was lowered from 24.5 mm Hg before to 11.4 mmHg after TIPS. Two early and three late occlusions were observed (primary patency rate 78 %). The rate of secondary inte rventions was 41 %. Five times a hepatic vein stenosis was dilatated a nd stented, two times an occluded shunt was recanalized, two times a n ew shunt was created parallel to an occluded (secondary patency rate w ithin a maximum of 16 months 95 %). In two patients sepsis occurred wh ich was effectively treated with antibiotics, two patients died shortl y after TIPS due to hepatorenal syndrome and hepatic failure, respecti vely. There was no recurrent bleeding. Two patients developed hepatic encephalopathy; both improved after protein restriction. The authors c onclude that TIPS is an alternative procedure to shunt surgery, especi ally for patients who cannot benefit from sclerotherapy.