CLINICAL EVENTS AFTER TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT -CORRELATION WITH HEMODYNAMIC-FINDINGS

Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS ) procedures are increasingly being used, but the relationship between the hemodynamic effects of TIPS and the clinical events on follow-up remains undefined. Hence, we have investigated the hemodynamic correla tions of portal hypertension-related events after a TIPS procedure. Me thods: Prospective follow-up of 122 cirrhotic patients who had a TIPS procedure performed because of variceal hemorrhage was conducted. Resu lts: The portacaval pressure gradient (PPG) significantly decreased af ter the TIPS procedure (from 19.7 +/- 4.6 to 8.6 +/- 2.7 mm Hg; P > 0. 001), but increased thereafter and at rebleeding (n = 25) was >12 mm H g in all patients (18.4 +/- 4.6 mm Hg). Twenty-six patients developed ascites; the PPG (measured in 19) was always >12 mm Hg. Increasing the PPG to >12 mm Hg occurred very frequently (83% at 1 year). Within 1 y ear, 77% of patients underwent balloon angioplasty or restenting. Howe ver, 80% had again a PPG of >12 mm Hg 1 year after reintervention. Hep atic encephalopathy developed in 31% of patients at 1 year; 21 of 23 p atients had a PPG of <12 mm Hg. Conclusions: Total protection from the risk of recurrent complications of portal hypertension after a TIPS p rocedure requires that the PPG be decreased and maintained <12 mm Hg. However, reintervention will be required in most patients within 1 yea r and again the second year. On the other hand, such portal decompress ion is associated with an increased risk of hepatic encephalopathy.