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Transjugular intrahepatic portosystemic shunt: efficacy for the treatment of portal hypertension and impact on liver transplantation.
Am Surg. 1996 Oct; 62(10):835-9.AS

Abstract

Variceal bleeding (VB) and ascites refractory to diuretics (RA) represent a significant cause of morbidity and mortality in patients with portal hypertension. Transjugular intrahepatic portosystemic shunts (TIPS) have been used effectively in patients with these complications, especially those individuals awaiting orthotopic liver transplantation (OLT). From April 1992 to July 1995, 41 adult patients underwent an attempt at TIPS placement for refractory VB or ascites at Cedars-Sinai Medical Center. Technical success was achieved in 37 of 41 cases (90.3%) with only two technical complications. Immediate control of hemorrhage and significant improvement of ascites was obtained in 91.9% and 83.5% of the patients, respectively. Six patients (16.2%) died within a week of TIPS placement due to uncontrollable ascites and multiorgan failure. Four of 31 patients (12.9%) developed mild to moderate grades of hepatic encephalopathy that was controlled with lactulose. Rebleeding from recurrent portal hypertension was noted in 5 of 31 cases (16.1%). Shunt stenosis or occlusion was seen in 7 of 31 cases (22.6%) at an average of 6.3 months following TIPS placement. Six patients underwent OLT within an average of 87 days after TIPS. These results indicate that TIPS appears to be an effective method for treatment of refractory VB and RA, especially for patients who are poor candidates for a surgical shunt or awaiting OLT. However, TIPS may not be considered a definitive solution for all patients with portal hypertension because of its current rate of shunt occlusion or stenosis.

Authors+Show Affiliations

Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8813166

Citation

Cosenza, C A., et al. "Transjugular Intrahepatic Portosystemic Shunt: Efficacy for the Treatment of Portal Hypertension and Impact On Liver Transplantation." The American Surgeon, vol. 62, no. 10, 1996, pp. 835-9.
Cosenza CA, Hoffman AL, Friedman ML, et al. Transjugular intrahepatic portosystemic shunt: efficacy for the treatment of portal hypertension and impact on liver transplantation. Am Surg. 1996;62(10):835-9.
Cosenza, C. A., Hoffman, A. L., Friedman, M. L., Sher, L. S., Lopez, R. R., Van Allen, R., Brown, D. H., Fraiman, M. H., Arnaout, W., Vierling, J., & Makowka, L. (1996). Transjugular intrahepatic portosystemic shunt: efficacy for the treatment of portal hypertension and impact on liver transplantation. The American Surgeon, 62(10), 835-9.
Cosenza CA, et al. Transjugular Intrahepatic Portosystemic Shunt: Efficacy for the Treatment of Portal Hypertension and Impact On Liver Transplantation. Am Surg. 1996;62(10):835-9. PubMed PMID: 8813166.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transjugular intrahepatic portosystemic shunt: efficacy for the treatment of portal hypertension and impact on liver transplantation. AU - Cosenza,C A, AU - Hoffman,A L, AU - Friedman,M L, AU - Sher,L S, AU - Lopez,R R, AU - Van Allen,R, AU - Brown,D H, AU - Fraiman,M H, AU - Arnaout,W, AU - Vierling,J, AU - Makowka,L, PY - 1996/10/1/pubmed PY - 1996/10/1/medline PY - 1996/10/1/entrez SP - 835 EP - 9 JF - The American surgeon JO - Am Surg VL - 62 IS - 10 N2 - Variceal bleeding (VB) and ascites refractory to diuretics (RA) represent a significant cause of morbidity and mortality in patients with portal hypertension. Transjugular intrahepatic portosystemic shunts (TIPS) have been used effectively in patients with these complications, especially those individuals awaiting orthotopic liver transplantation (OLT). From April 1992 to July 1995, 41 adult patients underwent an attempt at TIPS placement for refractory VB or ascites at Cedars-Sinai Medical Center. Technical success was achieved in 37 of 41 cases (90.3%) with only two technical complications. Immediate control of hemorrhage and significant improvement of ascites was obtained in 91.9% and 83.5% of the patients, respectively. Six patients (16.2%) died within a week of TIPS placement due to uncontrollable ascites and multiorgan failure. Four of 31 patients (12.9%) developed mild to moderate grades of hepatic encephalopathy that was controlled with lactulose. Rebleeding from recurrent portal hypertension was noted in 5 of 31 cases (16.1%). Shunt stenosis or occlusion was seen in 7 of 31 cases (22.6%) at an average of 6.3 months following TIPS placement. Six patients underwent OLT within an average of 87 days after TIPS. These results indicate that TIPS appears to be an effective method for treatment of refractory VB and RA, especially for patients who are poor candidates for a surgical shunt or awaiting OLT. However, TIPS may not be considered a definitive solution for all patients with portal hypertension because of its current rate of shunt occlusion or stenosis. SN - 0003-1348 UR - https://www.unboundmedicine.com/medline/citation/8813166/Transjugular_intrahepatic_portosystemic_shunt:_efficacy_for_the_treatment_of_portal_hypertension_and_impact_on_liver_transplantation_ L2 - http://www.diseaseinfosearch.org/result/5881 DB - PRIME DP - Unbound Medicine ER -