Patency and reintervention rates during routine TIPSS surveillance |
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Authors: | Joanne Latimer Sadeeq M Bawa Colin J Rees Mark Hudson John D G Rose |
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Institution: | (1) Department of Radiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK, GB;(2) Liver Unit, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK, GB |
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Abstract: | Purpose: To assess the medium-term outcome of transjugular intrahepatic portosystemic stent shunts (TIPSS) by measuring the incidence
of shunt obstruction or failure during routine surveillance and the number of interventions performed.
Methods:This is a retrospective study covering a 4-year period, from 1992 to 1996, during which 102 TIPSS procedures were performed.
Indications for treatment were variceal bleeding (76%) and refractory ascites (24%). Follow-up protocol after TIPSS included
transfemoral or transjugular portal venography and measurement of portosystemic pressure gradient (PPG) at 3 months, 12 months,
and then at yearly intervals. The results of the first 155 venograms on 62 patients (mean follow-up 14 months) have been reviewed
and Kaplan-Meier analysis performed.
Results: One hundred and thirty-seven of 155 (88%) examinations showed patent shunts. Fifty-six of 137 (41%) of the patent TIPSS had
elevated PPG with signs of stenosis. The majority (41/56) of shunt stenoses with elevated pressure gradients were related
to neointimal hyperplasia in the hepatic venous aspect of the shunt. Interventions used to reduce the pressure gradient or
to restore patency included: angioplasty (62/102 interventions), additional stents (21/102), a second TIPSS procedure (2/102),
and thrombolysis or thrombectomy (4/102). The primary patency rate was 66% at 1 year (52% at 2 years). Primary assisted patency
was 72% at 1 year (58% at 2 years). Secondary patency was 86% at 1 year (63% at 2 years).
Conclusion: The majority of TIPSS shunts will remain patent when regular portal venography, with appropriate intervention, is undertaken.
Although there is a high reintervention rate this mainly takes the form of balloon angioplasty. |
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Keywords: | : Shunts portosystemic— Liver interventional procedure— Hypertension portal— Liver cirrhosis |
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