[Intrahepatic portosystemic shunts]

We want to present our experience performed at the Institute of Radiology of Turin: 98 TIPS in 97 patients (in 1 patient, twice). METHODS. From March 1992, 97 cirrhotic patients (18 Child A, 48 Child B, 31 Child C) underwent the TIPS procedure for portal hypertension. The indications were digestive hemorrhage in 81 patients (20 of which performed in emergency for acute bleeding), intractable ascites in 13 patients and bleeding prevention in 3 patients. RESULTS. Immediate technical success was obtained in 95/98 cases (96.9%). Patients were monitored by US-Doppler at 24 hours, 2 months and every 6 months and by esophagogastroscopy at 2 and 6 months. Major clinical complications included CID (2 cases), hepatic failure (3 cases), renal insufficiency (2 cases), heart failure (1 case), recurrent bleeding (6 cases) and encephalopathy (15 cases). We had 5 early occlusion and 17 late stenosis of the shunt; 21 patients in this group were successfully treated either by PTA or restenting; one patient underwent a surgical shunt. Mortality rate follow-up was 0/17 among Child A patients, 7/48 (14.5%) among Child B patients and 12/29 (41.3%) among Child C patients. CONCLUSIONS. TIPS is a safe and valuable method for the treatment of portal hypertension. Though shunt stenosis may occur with a certain frequency (22/95, 23.1% in our study), a second intervention is usually effective in reducing gastro-oesophageal varices and ascites.