Incidence of shunt occlusion or stenosis following transjugular intrahepatic portosystemic shunt placement
| Autor: | William O. Richards, Christopher D. Lind, Wui Kheong Chong, Steven G. Meranze, C. Wright Pinson, Tim W. Malisch, Murray J. Mazer |
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| Rok vydání: | 1994 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.medical_treatment Hemorrhage Hepatic Veins Jugular vein Occlusion medicine Humans Portasystemic Shunt Surgical Prospective Studies Derivation Aged Hepatology medicine.diagnostic_test Portal Vein business.industry Vascular disease Liver Diseases Graft Occlusion Vascular Gastroenterology Middle Aged medicine.disease Shunt (medical) Surgery Stenosis Liver Angiography Female Radiology business Transjugular intrahepatic portosystemic shunt |
| Zdroj: | Gastroenterology. 106:1277-1283 |
| ISSN: | 0016-5085 |
| Popis: | Background/Aims: Transjugular intrahepatic portosystemic shunt (TIPS) placement has been used for the treatment of recurrent variceal hemorrhage. The 1-year incidence of shunt stenosis or occlusion after TIPS placement was prospectively assessed, and the accuracy of Doppler ultrasonography to predict TIPS stenosis was evaluated. Methods: Twenty-two patients with recurrent variceal hemorrhage were selected for TIPS placement between April 1991 and May 1992. Preoperative and postoperative evaluation included clinical assessment, upper gastrointestinal endoscopy, portal angiography with pressure measurements, and Doppler ultrasonography. Follow-up was performed at 3 and 12 months post-TIPS and when patients developed recurrent bleeding. Results: Twenty-one of 22 patients (Child-Pugh class A-1, B-11, C-9) had successful TIPS placement. Seventeen of 21 patients have completed follow-up for at least 12 months. Of these 17 patients, 2 of 17 (12%) developed TIPS occlusion, 7 of 17 (41%) developed shunt stenosis, and 8 of 17 (47%) showed no stenosis on follow-up angiography. Doppler ultrasonographic assessment of the TIPS predicted shunt stenosis or occlusion with 100% sensitivity, 98% specificity, and 90% positive predictive value. Conclusions: Shunt occlusion or stenosis develops frequently within 12 months after TIPS placement, and Doppler ultrasonography is accurate in the noninvasive assessment of shunt stenosis. TIPS placement without careful follow-up and shunt revision cannot be considered a long-term treatment of variceal hemorrhage. |
| Databáze: | OpenAIRE |
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