Transjugular intrahepatic portosystemic shunt in Vienna--a decade later

Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) for therapy of portal hypertension has been available in Vienna, Austria, since 1991. Ten years of experience with this technique led the Vienna TIPS Study Group to retrospectively analyse characteristics and outcome of all patients undergoing TIPS in Vienna between 1991 and 2001. Survival and subgroup analyses were performed using Mann Whitney U-tests, log-rank tests, Spearman's correlation and Kaplan-Meier analyses. A total of 523 patients underwent TIPS; 23 for acute variceal bleeding, 350 for prevention of variceal bleeding, and 109 for therapy of refractory ascites. Portal hypertension was caused by cirrhosis in 503 patients; 20 presented with other diseases. 253 patients died within the study period, median follow-up was 5.07 years, median survival 4.51 years. The 3-month, 1-year, 3-year, and 5-year survival rates were 83%, 71%, 57%, and 49%, respectively. Etiology of cirrhosis had no effect on survival; patients with TIPS for refractory ascites had poorer survival rates than those undergoing TIPS for prevention of rebleeding. TIPS is a safe and effective therapy for patients with portal hypertension. The first decade of TIPS in Vienna has shown, in line with other publications, that good criteria for patient selection, effective post-interventional management, and close cooperation between internists, interventional radiologists and liver-transplant centers are the key for a good outcome.