Liver, Pancreas, and Biliary TractClinical events after transjugular intrahepatic portosystemic shunt: Correlation with hemodynamic findings☆,☆☆
Section snippets
Patients and methods
This prospective study included 122 consecutive patients who were treated with a TIPS procedure between October 1992 and June 1995 at the two participating centers: Hospital Clinic i Provincial, University of Barcelona, and Hospital General Universitario Gregorio Marañón, University Complutense of Madrid. All patients treated with a TIPS procedure during that period were included in this study. The patient group included 81 men and 41 women with a mean age of 58 years (range, 27–78 years). All
Changes in portacaval pressure gradient
PPG was significantly decreased by placement of a TIPS (from 19.7 ± 4.6 to 8.6 ± 2.7 mm Hg; P < 0.0001). In 106 of 122 patients, the PPG was decreased to ≤12 mm Hg; in the remaining 16 patients, the final PPG ranged between 12.5 and 14 mm Hg. During follow-up examinations, a significant increase in PPG was observed. Mean PPG was 10.5 ± 2.5, 14.8 ± 2.4, and 16.5 ± 3.9 mm Hg at 2, 6, and 12 months, respectively, in spite of the fact that patients who were found to have a stenosed or occluded TIPS
Discussion
It is well established that a TIPS can prevent most of the complications of portal hypertension, such as variceal bleeding and ascites.2, 3, 4, 5, 6, 17, 18, 19 Other reports indicate that a TIPS may ameliorate the hepatorenal syndrome,20, 21, 22, 23 portal-hypertensive gastropathy,24 and hepatopulmonary syndrome.25 However, a major caveat of a TIPS is that its rate of occlusion is much higher than that observed after placement of surgical portosystemic shunts.2, 3, 12, 13, 26 This is caused in
Acknowledgements
The authors thank A. Baringo and L. Rocabert for their assistance in these studies and to D. Bird for secretarial support.
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Supported by grants 94/0757, 95/1016, and 97/1309 from Fondo de Investigaciones Sanitarias and by Dirección General de Investigación Científica y Técnica grant PB95-1562.
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Address requests for reprints to: Jaume Bosch, M.D., Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain. Fax: (34) 3-451-5272.