Document Detail

Transjugular intrahepatic portosystemic shunts: long-term patency and clinical results in a patient cohort observed for 3-9 years.
MedLine Citation:
PMID:  15044746     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To retrospectively assess the outcome of transjugular intrahepatic portosystemic shunt (TIPS) placement in a nonselected group of consecutive patients. MATERIALS AND METHODS: TIPS placement was attempted in 82 patients. Patients were followed up for at least 3 years according to a standard protocol that included repeated shunt evaluations. Fifty-four patients underwent TIPS placement for variceal bleeding, 24 for refractory ascites, and four for other indications. Recurrent bleeding, effect on ascites, long-term patency, development of encephalopathy, and survival and complication rates were evaluated with Kaplan-Meier survival analysis and Cox multivariate analysis. RESULTS: TIPS placement was successful in 75 patients (91%). Mean follow-up lasted 29.4 months. Primary patency was 22% and 12%, primary-assisted patency was 67% and 46%, and secondary patency was 91% and 91% at 1- and 5-year follow-up, respectively. Nonalcoholic liver disease (P =.007) and increasing platelet counts (P =.006) independently predicted development of shunt insufficiency. The 1- and 5-year rates of recurrent variceal bleeding were 21% and 27%, respectively. In the majority of patients with refractory ascites, a beneficial effect of TIPS placement was observed. The risk for encephalopathy was 25% at 1-month follow-up and 52% at 3-year follow-up. The risk for chronic or severe intermittent encephalopathy was 15% at 1-year follow-up and 20% at 3-year follow-up. Serum creatinine levels (P =.001) and age (P =.02) were independent risk factors. Overall survival rate was 61%, 49%, and 42% at 1-, 3-, and 5-year follow-up, respectively. Age (P =.03), serum albumin level (P =.02), and serum creatinine level (P <.001) were independently related to mortality. CONCLUSION: The risk for definitive loss of shunt function was 17% at 5-year follow-up, indicating that surveillance with shunt revision-when indicated-results in excellent long-term TIPS patency. TIPS placement effectively protects against recurrent bleeding.
Pieter C J ter Borg; Mirjam Hollemans; Henk R Van Buuren; Frank P Vleggaar; Michael Groeneweg; Wim C J Hop; Johan S Laméris
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Publication Detail:
Type:  Journal Article     Date:  2004-03-24
Journal Detail:
Title:  Radiology     Volume:  231     ISSN:  0033-8419     ISO Abbreviation:  Radiology     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-05-06     Completed Date:  2004-06-29     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  537-45     Citation Subset:  AIM; IM    
Department of Gastroenterology and Hepatology, Erasmus MC, Dr. Molewaterplein 40, Room Ca 326, 3015 GD Rotterdam, The Netherlands.
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MeSH Terms
Cohort Studies
Hemorrhage / epidemiology
Hepatic Encephalopathy / epidemiology
Middle Aged
Portasystemic Shunt, Transjugular Intrahepatic* / mortality
Postoperative Complications / epidemiology
Retrospective Studies
Survival Rate
Time Factors
Vascular Patency

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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