Transjugular intrahepatic portosystemic shunts: midterm results in 28 patients

This paper reports the clinical and procedural results of 28 consecutive TIPS procedures in 25 males and three females with a mean age of 48 years. All patients had cirrhosis with portal hypertension and varices. Twenty-two patients had recurrent bleeding. Shunts were completed in 26 of 28 patients, and no death was associated with the procedure. Portal vein pressure was reduced from 3.98 +/- 0.24 KPa before shunting to 2.40 +/- 0.16 KPa after shunting. Doppler US revealed that the maximum blood flow velocity in the main portal vein increased from 14.0 +/- 4.5 cm/sec to 48.0 +/- 16.5 cm/sec. Shunt patency was determined by color Doppler US in 20 patients. Shunt stenosis was found in five patients and occlusion in one, and these findings were confirmed by angiography. Ascites disappeared in six of eight cases, and varices disappeared completely in 11 patients and abated greatly in 12 patients two months after TIPS. Rebleeding occurred in three cases (occlusion, 1; stenosis, 2) during a mean follow-up time of 6.5 months. One of these cases was successfully redilated. The initial results suggest that TIPS is a safe and effective method of portal decompression and that the key to portal vein puncture is to understand the three-dimensional relationship between the hepatic and portal veins.