Radiology, Vol 196, 335-340, Copyright © 1995 by Radiological Society of North America
Multicenter investigation of the role of transjugular intrahepatic portosystemic shunt in management of portal hypertension
DM Coldwell, EJ Ring, CR Rees, G Zemel, MD Darcy, ZJ Haskal, MA McKusick and AJ Greenfield
Department of Radiology, University of Washington Medical Center, Seattle 98195, USA.
PURPOSE: To determine the safety and efficacy of transjugular intrahepatic
portosystemic shunt (TIPS) placement, a prospective multicenter trial was
undertaken. MATERIALS AND METHODS: In eight institutions, 96 patients
underwent TIPS placement after failed sclero- therapy (Child-Pugh class A
[n = 24], class B [n = 38], and class C [n = 34]), with follow-up for 6
months (with ultrasonography and angiography and clinical and laboratory
studies). RESULTS: TIPS placement was successful in all patients (mean
initial portosystemic pressure gradient, 22.8 mm Hg + 6.7 [standard
deviation]; mean decrease after placement, 12.8 mm Hg + 5.2), with variceal
embolization in 25 patients. Complications included liver capsule puncture
(n = 12), hepatic artery puncture (n = 3), main portal vein puncture (n =
1), and increased encephalopathy (n = 28). The 30-day mortality rate was 0%
for patients with Child class A disease, 18% for class B, and 40% for class
C. At 6 months, primary patency was 88% and assisted patency was 94%.
CONCLUSION: The risk associated with TIPS placement is reasonable, and it
is an effective procedure for the treatment of portal hypertension.
