[First experience with transjugular intrahepatic porto-systemic shunt (TIPS)]

Transjugular intrahepatic portosystemic shunt (TIPS) is a radiological interventional procedure for the treatment of portal hypertension. This is a percutaneous method that lowers the elevated portal pressure by creating an intrahepatic shunt between the portal vein and one of the hepatic veins. TIPS carries lower risk than surgical portosystemic shunt, and prevents rebleeding from oesophageal varices more effectively than sclerotherapy. Since September 1999 the authors performed--with revisions--30 TIPS procedures in 20 patients. (Some patients needed more than one attempt.) We summarise our practice in patient selection, preoperative evaluation, followed by a detailed description of the technique of TIPS. Intensive monitoring and special issues of anaesthesia are also described. Technical success rate was 95%. Ninety-three percent of patients improved clinically. Despite some complications, no immediate mortality was noted. Two patients died within 30 days (both Child C). Average portosystemic gradient was reduced from 19.4 Hgmm to 9.6 Hgmm. No esophageal varix rebleeding occurred with patent shunt, and no ascites drainage was needed, either. 17% of patients developed encephalopathy requiring treatment. Our short follow-up time (average 6 months, longest 21 months) does not allow correct comparison with the 2-years survival of severe cirrhotic patients, but according to the literature TIPS does not change it significantly.