Transjugular intrahepatic portosystemic shunt: initial clinical experience and three-year follow-up

To define the role of transjugular intrahepatic portosystemic shunt (TIPS), we prospectively studied 12 patients undergoing this procedure for variceal bleeding, refractory ascites, and hemorrhagic gastropathy due to portal hypertension. The TIPS creation was successful in 11 patients, and portal pressure immediately decreased an average of 8.3 cm H2O. Esophageal varices improved in six of seven patients, but gastric varices with spleno- or gastro-renal shunt did not change in three of four patients. A hemorrhage from portal hypertensive gastropathy was controlled immediately. Ascites improved in all six patients. Hepatic encephalopathy newly developed in four patients, but was controllable with medical treatment. During the follow-up period (mean, 25 months), shunt dysfunction was evident in eight of 10 patients. Stenosis and occlusion of the shunt were successfully treated by redilatation and/or placement of an additional stent. The cumulative survival rate was 73% at one year and 64% at two years. These results suggest that TIPS is a safe and effective treatment for uncontrollable complications due to portal hypertension, but is not effective for gastric varices with spleno- or gastro-renal shunt. Careful follow-up and shunt revision are necessary for the maintenance of shunt patency.