TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT SHUNT - A 2-YEAR FOLLOW-UP

Transjugular intrahepatic portosystemic stent shunt (TIPSS) is a new nonoperative treatment of portal hypertension. The technique is based on the transjugular introduction of an expandable vascular stent which is implanted into the liver parenchyma between a main branch of the portal vein and a hepatic vein. Twelve patients with liver cirrhosis and recurrent variceal hemorrhage, who were excluded from operative treatment, were included in a pilot study. All patients either refused surgery or were considered poor surgical candidates. TIPSS was successfully established in 9 of the patients (75%). 58% of the patients survived 12 months and 50% 24 months. Variceal rebleeding occurred in 1 patient. Aggravation of hepatic encephalopathy was found in 1 patient. The results of this pilot study indicate that TIPSS controls variceal bleedings effectively during a follow-up of up to 2 years. It may be suitable for patients with advanced liver disease and high operative risk. It also does not limit later consideration for liver transplantation. During the course of the study, refinements of the technique have led to an even safer procedure which generally can be completed in 1-2 h.