[The intrahepatic portosystemic shunt. Initial clinical experiences with patients with liver cirrhosis]

A new nonoperative catheter technique to perform an intrahepatic portosystemic shunt by transjugular approach was applied to ten patients with recurrent bleeding from oesophageal and fundal varices. Therefore a balloon-expandable stent was placed between a portal vein and a hepatic vein. Implantation of the stent was successful in seven of the ten patients. Two of these seven patients died 10 and 11 days, respectively, after the procedure, one of them in consequence of respiratory failure, the other due to an uncontrollable bleeding from the site of the percutaneous transhepatic puncture because of a marked clotting disorder. The intrahepatic shunt construction led to a mean reduction of the pressure gradient between portal and hepatic vein of 40%. No recurrence of variceal haemorrhage occurred during the average follow-up time of 5.6 months (3-9 months). One patient developed several episodes of portosystemic encephalopathy. The transjugular intrahepatic portosystemic shunt is effective in the treatment of portal hypertension and might become an alternative to shunt surgery.