A retrospective study of the efficacy of transjugular intrahepatic portosystemic shunts

Transjugular intrahepatic portosystemic shunts (TIPS) are being used increasingly for complications of portal hypertension, including active and recurrent variceal hemorrhage and intractable ascites, as well as for portal decompression in patients awaiting orthotopic liver transplantation. We reviewed the initial 2-year experience with TIPS at Louisiana State University Medical Center-Shreveport and Willis-Knighton Medical Center, Shreveport, Louisiana, which involved 31 patients. Clinical findings (with some patients having more than one finding) revealed that 16 per cent (five) of the patients had active hemorrhage; 61 per cent (19), multiple episodes of (recurrent) variceal hemorrhage; and 48 per cent (15), ascites. The mean follow-up period was 6.2 months, with a patient mortality of 13 per cent. Results showed that in 87 per cent (27 of 31) of patients the TIPS procedure was successfully placed. There was 100 per cent control of active variceal hemorrhage (five patients) and ascites (12 patients; excludes three patients who died). Rebleeding occurred in 18 per cent (four of 22) of patients, all related to stenosis or occlusion of the TIPS. The overall incidence of occlusion and stenosis was 11 per cent and 22 per cent, respectively. Seventy-seven per cent (seven of nine) of the patients experiencing the latter complications underwent successful angioplasty or revision of their TIPS. The results of our experience indicate that TIPS placement can be performed successfully with low procedural morbidity. The procedure is effective in controlling active variceal hemorrhage refractory to endoscopic sclerotherapy. The use of TIPS may be particularly beneficial for patients who are either awaiting liver transplantation or poor candidates for surgical shunt procedures. TIPS may not be a long-term solution for patients with portal hypertension, given the current rates of occlusion and stenosis.