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Conversion of failed transjugular intrahepatic portosystemic shunt to distal splenorenal shunt in patients with Child A or B cirrhosis.
Ann Surg. 1998 Apr; 227(4):600-3.AnnS

Abstract

OBJECTIVE

The authors demonstrate the feasibility of converting failed transjugular intrahepatic portosystemic shunt (TIPS) to distal splenorenal shunt (DSRS) in patients with good hepatic reserve for long-term control of variceal bleeding.

SUMMARY BACKGROUND DATA

TIPS is an effective method for decompressing the portal venous system and controlling bleeding from esophageal and gastric varices. TIPS insufficiency is, however, a common problem, and treatment alternatives in patients with an occluded TIPS are limited because most have already failed endoscopic therapy.

METHODS

The records of five patients who underwent conversion from TIPS to DSRS because of TIPS failure or complication in the past 36 months were reviewed.

RESULTS

Four patients had ethanol-induced cirrhosis and one patient had hepatitis C virus cirrhosis. Three patients were Child-Pugh class A and two were class B. All patients had excellent liver function, with galactose elimination capacities ranging from 388 to 540 mg/min (normal 500 +/- 100 mg/min). The patients had TIPS placed for acute (2) or sclerotherapy-resistant (3) variceal hemorrhage. All five TIPS stenosed 3 to 23 months after placement, with recurrent variceal hemorrhage and failed TIPS revision. One patient had stent migration to the superior mesenteric vein that was removed at the time of DSRS. All five patients underwent successful DSRS, and none have had recurrent hemorrhage 18 to 36 months after surgery.

CONCLUSIONS

TIPS provides inadequate long-term therapy for some Child-Pugh A or B patients with recurrent variceal hemorrhage. TIPS failure in patients with good liver function can be salvaged by DSRS in many cases.

Authors+Show Affiliations

Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9563552

Citation

Selim, N, et al. "Conversion of Failed Transjugular Intrahepatic Portosystemic Shunt to Distal Splenorenal Shunt in Patients With Child a or B Cirrhosis." Annals of Surgery, vol. 227, no. 4, 1998, pp. 600-3.
Selim N, Fendley MJ, Boyer TD, et al. Conversion of failed transjugular intrahepatic portosystemic shunt to distal splenorenal shunt in patients with Child A or B cirrhosis. Ann Surg. 1998;227(4):600-3.
Selim, N., Fendley, M. J., Boyer, T. D., Galloway, J. R., & Branum, G. D. (1998). Conversion of failed transjugular intrahepatic portosystemic shunt to distal splenorenal shunt in patients with Child A or B cirrhosis. Annals of Surgery, 227(4), 600-3.
Selim N, et al. Conversion of Failed Transjugular Intrahepatic Portosystemic Shunt to Distal Splenorenal Shunt in Patients With Child a or B Cirrhosis. Ann Surg. 1998;227(4):600-3. PubMed PMID: 9563552.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Conversion of failed transjugular intrahepatic portosystemic shunt to distal splenorenal shunt in patients with Child A or B cirrhosis. AU - Selim,N, AU - Fendley,M J, AU - Boyer,T D, AU - Galloway,J R, AU - Branum,G D, PY - 1998/5/1/pubmed PY - 1998/5/1/medline PY - 1998/5/1/entrez SP - 600 EP - 3 JF - Annals of surgery JO - Ann Surg VL - 227 IS - 4 N2 - OBJECTIVE: The authors demonstrate the feasibility of converting failed transjugular intrahepatic portosystemic shunt (TIPS) to distal splenorenal shunt (DSRS) in patients with good hepatic reserve for long-term control of variceal bleeding. SUMMARY BACKGROUND DATA: TIPS is an effective method for decompressing the portal venous system and controlling bleeding from esophageal and gastric varices. TIPS insufficiency is, however, a common problem, and treatment alternatives in patients with an occluded TIPS are limited because most have already failed endoscopic therapy. METHODS: The records of five patients who underwent conversion from TIPS to DSRS because of TIPS failure or complication in the past 36 months were reviewed. RESULTS: Four patients had ethanol-induced cirrhosis and one patient had hepatitis C virus cirrhosis. Three patients were Child-Pugh class A and two were class B. All patients had excellent liver function, with galactose elimination capacities ranging from 388 to 540 mg/min (normal 500 +/- 100 mg/min). The patients had TIPS placed for acute (2) or sclerotherapy-resistant (3) variceal hemorrhage. All five TIPS stenosed 3 to 23 months after placement, with recurrent variceal hemorrhage and failed TIPS revision. One patient had stent migration to the superior mesenteric vein that was removed at the time of DSRS. All five patients underwent successful DSRS, and none have had recurrent hemorrhage 18 to 36 months after surgery. CONCLUSIONS: TIPS provides inadequate long-term therapy for some Child-Pugh A or B patients with recurrent variceal hemorrhage. TIPS failure in patients with good liver function can be salvaged by DSRS in many cases. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/9563552/Conversion_of_failed_transjugular_intrahepatic_portosystemic_shunt_to_distal_splenorenal_shunt_in_patients_with_Child_A_or_B_cirrhosis_ L2 - https://Insights.ovid.com/pubmed?pmid=9563552 DB - PRIME DP - Unbound Medicine ER -