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Transjugular intrahepatic portosystemic shunt creation in children: initial clinical experience
C A Hackworth1, J A Leef, J D Rosenblum
1Department of Radiology, University of Chicago Hospitals, IL 60637, USA.
Insights
Transjugular intrahepatic portosystemic shunt (TIPS) creation is safe and effective for managing pediatric portal hypertension. This procedure offers a viable treatment option, particularly for children awaiting liver transplantation.
Area of Science:
- Pediatric Interventional Radiology
- Hepatology
- Vascular Surgery
Background:
- Portal hypertension in children can lead to severe complications.
- Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for portal hypertension in adults.
- Limited data exists on TIPS efficacy and safety in pediatric populations.
Purpose of the Study:
- To evaluate the initial clinical experience with transjugular intrahepatic portosystemic shunt (TIPS) creation in children.
- To assess the technical feasibility and safety of TIPS in a pediatric cohort.
Main Methods:
- Twelve consecutive pediatric patients with portal hypertension complications underwent TIPS creation.
- A standard radiographic technique was employed for the procedures.
- Patient demographics included age range from 2 years 5 months to 16 years 10 months.
Main Results:
- Twelve successful TIPS creations were achieved out of thirteen procedures.
- No major procedural complications or morbidity were observed.
- TIPS patency was confirmed in 10 children at liver transplantation; one case of shunt stenosis was successfully treated.
Conclusions:
- Transjugular intrahepatic portosystemic shunt (TIPS) creation is technically feasible and safe in children.
- TIPS can effectively manage pediatric portal hypertension, providing temporary relief before liver transplantation.
- This initial experience supports TIPS as a valuable therapeutic option for children with portal hypertension.
Purpose:
To assess an initial clinical experience with the creation of a transjugular intrahepatic portosystemic shunt (TIPS) in children.
Materials And Methods:
Twelve consecutive patients with complications of portal hypertension underwent TIPS creation at our institution between July 1993 and September 1996. There were six boys and six girls aged 2 years 5 months to 16 years 10 months (median, 9 years 2 months) who weighed 13.9-80.9 kg (median, 27.65 kg). A standard radiographic technique was used.
Results:
Thirteen procedures were performed to achieve 12 successful TIPS creations. One child with a reduced-size liver transplant had to undergo two procedures for a successful TIPS creation. No major procedural complications or morbidity occurred. In 10 children, TIPS patency was documented by means of pathologic inspection at orthotopic liver transplantation (median shunt duration, 53 days). Shunt stenosis developed in one child at 186 days but was treated successfully. Two children had functional shunts at 301 and 357 days, respectively. No episodes of repeat variceal hemorrhage were noted. One child developed postprocedural encephalopathy, which responded to medical therapy.
Conclusion:
This initial clinical experience suggests that TIPS creation is technically feasible and is as safe in children as in adults. TIPS creation can aid in the management of portal hypertension in children, especially in those needing temporary relief before liver transplantation.