RESUMO
PURPOSE: To evaluate the frequency and significance of stenoses or occlusions developing within transjugular intrahepatic portosystemic shunts (TIPS) and identify predictive factors. MATERIALS AND METHODS: Medical records of 52 patients who underwent TIPS placement between September 1991 and October 1993 were reviewed. Various shunt parameters were correlated with the development of shunt abnormalities. Findings at follow-up portography and frequency of variceal bleeding and paracentesis were also noted. RESULTS: Twenty-four patients were followed up for at least 6 months. In eight patients, stenoses developed within 6 months; one shunt occluded. No clear correlations were found between shunt parameters and development of shunt abnormalities. Two of four patients with recurrent variceal bleeding had associated shunt abnormalities. The frequency of stenosis of TIPS was high. CONCLUSION: Early detection and prompt revision of stenotic shunts may decrease the frequency of recurrent variceal bleeding and ascites.
Assuntos
Complicações Pós-Operatórias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Criança , Pré-Escolar , Constrição Patológica , Feminino , Seguimentos , Veias Hepáticas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Sistema Porta/diagnóstico por imagem , Derivação Portossistêmica Cirúrgica , Portografia , Complicações Pós-Operatórias/diagnóstico , Radiografia Intervencionista , Estudos Retrospectivos , Sensibilidade e Especificidade , Stents , Análise de Sobrevida , UltrassonografiaRESUMO
PURPOSE: To evaluate the transjugular intrahepatic portosystemic shunt (TIPS) in treatment of refractory ascites. MATERIALS AND METHODS: Fourteen patients with chronic liver disease and portal hypertension were included in a prospective study. Six patients had Child-Pugh class B disease; eight had class C disease. Indications for TIPS were three previous hospital admissions over 9 months for treatment of tense ascites, no response to diuretic therapy, or an occluded peritoneovenous shunt with tense ascites. The volume of ascitic fluid was sonographically evaluated before and after TIPS placement. RESULTS: The technical success rate for TIPS creation was 93%. Mean portosystemic gradient decreased from 22.8 mm Hg +/- 7.2 before TIPS placement to 11.3 mm Hg +/- 3.6 after TIPS (P = .005). Complete resolution of ascites was achieved in seven (50%) patients. Treatment failed in seven; five had Child-Pugh class C disease, and four of these had a Child-Pugh score greater than 11. CONCLUSION: These results are comparable to those for other forms of treatment of ascites. The authors do not, however, recommend TIPS in patients with a Child-Pugh score greater than 11.