Radiology, Vol 192, 235-240, Copyright © 1994 by Radiological Society of North America
Variceal hemorrhage: efficacy of transjugular intrahepatic portosystemic shunts created with Strecker stents
AJ Echenagusia, F Camunez, G Simo, J Peiro, MG Garay, JM Rodriguez Laiz and R Banares
Department of Radiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.
PURPOSE: To evaluate the efficacy of transjugular intrahepatic
portosystemic shunts (TIPS) in treatment of variceal hemorrhage. MATERIALS
AND METHODS: Forty-five patients with cirrhosis underwent TIPS placement
for treatment of acute (n = 12) or recurrent (n = 33) variceal hemorrhage.
Shunts were created with Strecker stents. RESULTS: Shunts were established
by deployment of stents in 42 patients. The portosystemic pressure gradient
decreased from an average of 20.4 mm Hg +/- 5.4 to 9.2 mm Hg +/- 4.1.
Complications included hepatic failure (n = 1), acute shunt thrombosis (n =
2), right jugular vein thrombosis (n = 1), bacteremia (n = 1), and stent
misplacement (n = 1). Acute bleeding was controlled in 12 patients. The
30-day mortality rate was 2%; four other patients have since died. During
follow-up (mean, 8.9 months), variceal bleeding recurred in six patients.
Hepatic encephalopathy developed in six patients. Shunt stenosis or
occlusion requiring further intervention occurred in 20 patients.
CONCLUSION: TIPS are safe and effective in treatment of variceal
hemorrhage; however, secondary interventions are often required to preserve
shunt function.
