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Transjugular intrahepatic portosystemic shunt placement for variceal bleeding: predictors of mortality
C E Encarnacion1, J C Palmaz, F J Rivera
1Department of Radiology, University of Texas Health Science Center, San Antonio 78284-7800, USA.
Purpose:
To identify factors that predict survival in patients with variceal bleeding who have undergone transjugular intrahepatic portosystemic shunt (TIPS) placement.
Patients And Methods:
TIPS was performed in 64 of 65 patients. Indications were bleeding esophagogastric varices in 64 patients and hemorrhoidal bleeding in one. Child-Pugh classifications were A in two patients, B in 32, and C in 31. Acute bleeding was controlled before TIPS in 26 patients in stable condition but not in 39 patients whose condition was unstable.
Results:
Twelve patients died within 30 days of TIPS, and another 14 died thereafter. The cumulative survival rate was 67% at 6 months and 56% at 1 year. Cumulative 30-day survival was 96% for stable and 69% for unstable patients, a significant difference (P = .0135). Thirty-day survival was 91% for patients in Child-Pugh classes A and B combined and 71% for patients in class C (P = .042).
Conclusion:
Efforts to control acute bleeding and improve a patient's metabolic status before TIPS are likely to improve 30-day survival.