TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT-SHUNT IN THE TREATMENT OF PORTAL-HYPERTENSION

The transjugular intrahepatic portosystemic stent-shunt is a new interventional treatment for portal hypertension, based on the creation of a parenchymal channel between a hepatic vein and a main branch of the portal vein. The implantation of expandable vascular stents into the tissue tract is mandatory for long-term patency. The procedure is safe and can be performed successfully in up to 95% of patients. The clinical results available to date suggest that the transjugular intrahepatic portosystemic stent-shunt is comparable to surgical shunts in preventing variceal rebleeding and hepatic encephalopathy, but has a much lower operative mortality. The 1- to 2-year mortality rate is comparable to the best results obtained by surgical shunts or sclerotherapy. The future refinement of the technique, the stents themselves, and the postprocedural management may further improve the clinical results. Randomized trials are needed to define the place of the transjugular intrahepatic portosystemic stent-shunt among other current treatments.