Details

Autor(en) / Beteiligte

• Forster, Jameson
• Delcore, Romano
• Payne, K. Mark
• Siegel, Edward L.

Titel

The role of transjugular intrahepatic portosystemic shunts in the management of patients with end-stage liver disease

Ist Teil von

• The American journal of surgery, 1994, Vol.168 (6), p.592-597

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

1994

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• Transjugular intrahepatic portosystemic shunt (TIPS) has been reported to successfully treat complications of portal hypertension; however, not all reports have been favorable. Forty patients underwent 41 attempts to place a TIPS. All patients but 1 had a Wallstent placed. Thirty-nine procedures (95%) were successful. Thirty-one patients were treated for gastrointestinal bleeding, and 9 for refractory ascites. The average fall in portal pressure was 13.7 ± 0.9 mm Hg. Major postprocedure complications included 4 deaths. Minor problems included liver capsular perforation, fever, self-limited bleeding, and a pseudoaneurysm. Follow-up evaluation revealed that by 5 months, 50% of the shunts developed a portal-venous-to-right-atrial pressure gradient requiring balloon dilatation or a new stent. The 1-year actuarial patient survival was 72%. Eighteen patients were candidates for orthotopic liver transplantation (OLT) and 5 have been transplanted. TIPS may be best used for stabilization, prior to OLT or as a temporizing measure prior to elective shunt surgery.