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Transjugular Intrahepatic Portosystemic Shunts: Long-term Patency and Clinical Results in a Patient Cohort Observed for 3–9 Years

¹ From the Department of Gastroenterology and Hepatology (P.C.J.t.B., M.H., H.R.v.B., F.P.V., M.G.) and Department of Epidemiology and Biostatistics (W.C.J.H.), Erasmus MC, Dr. Molewaterplein 40, Room Ca 326, 3015 GD Rotterdam, the Netherlands; and Department of Radiology, Academic Medical Centre, Amsterdam, the Netherlands (J.S.L.). Received December 30, 2002; revision requested March 4, 2003; final revision received September 11; accepted October 21. Address correspondence to P.C.J.t.B. (e-mail: pterborg@zonnet.nl).

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.

© RSNA, 2004

Index terms: Hypertension, portal, 95.1268 • Liver, interventional procedures, 95.1268 • Shunts, protosystemic, 95.453 • Stents and prostheses, 95.1268

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