[Transjugular portacaval shunt. Preliminary experience]

Area of Science:

• Interventional Radiology
• Hepatology
• Vascular Surgery

Background:

• Gastric and esophageal variceal rebleeding poses a significant risk in patients with cirrhosis.
• Transjugular intrahepatic portosystemic stent-shunt (TIPS) is an emerging interventional radiology technique.
• The procedure involves creating an intrahepatic shunt between the portal and hepatic veins, maintained by a metallic stent.

Purpose of the Study:

• To evaluate the efficacy and safety of TIPS in patients experiencing recurrent gastric or esophageal variceal bleeding.
• To assess the impact of TIPS on portal pressure, portal blood flow, and ascites.
• To determine the rate of complications and rebleeding following TIPS procedures.

Main Methods:

• A cohort of 32 patients with a history of gastric or esophageal variceal rebleeding underwent TIPS between July 1990 and March 1992.
• Patients were classified using the Child Pugh's classification (A, B, or C).
• Follow-up included clinical assessment, duplex-sonography for shunt patency, and monitoring for complications and rebleeding for up to 20 months.

Main Results:

• TIPS significantly reduced the portal pressure gradient by 57% and improved portal blood flow by 250%.
• Early complications included hemobilia, intra-abdominal bleeding, and gastrointestinal bleeding; one death was technique-related.
• Ascites improved in 55% of patients, with 100% reduction or disappearance by 3 months.
• Shunt stenosis was observed in 43% of patients, managed by redilatation.
• Variceal rebleeding occurred in 20% of cases.

Conclusions:

• TIPS is an effective procedure for managing gastric or esophageal variceal rebleeding in cirrhotic patients.
• The technique leads to significant hemodynamic improvements and amelioration of ascites.
• While complications can occur, they are often manageable, and TIPS offers a valuable therapeutic option for high-risk patients.