Fifteen years’ experience with transjugular intrahepatic portosystemic shunt (TIPS) using bare stents: retrospective review of clinical and technical aspects

Abstract

Purpose. The authors present a retrospective analysis of a large series of patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement. Materials and methods. Between March 1992 and December 2006, 658 patients were referred to our centre for TIPS placement. Indications for the procedure were digestive tract bleeding (52.8%), refractory ascites (35.3%), preservation of portal vein patency prior to liver transplantation (3.0%) and thrombosis of the suprahepatic veins (2.3%). Other indications (6.6%) included pleural ascites, portal thrombosis and hepatorenal and hepatopulmonary syndromes. All patients were evaluated with colour Doppler ultrasonography and in a few cases with computed tomography. The portal system was punctured under sonographic guidance. Wallstent, Palmaz and Nitinol thermosensitive stents were used. Embolisation of persistent varices was performed in 6.8% of cases. Results. Technical success was 98.9%. During a 1,500-day follow-up, the cumulative incidence of stent revision was 25.7% (Nitinol), 32.9% (Wallstent) and 1.8% (Palmaz). Mortality rates were 31.1%, 38.5% and 56.4%, respectively. The technical complications included six cases of heart failure, six of haematobilia, three of stent migration, two of intrahepatic haematoma and one of haemoperitoneum. Eight patients with severe portosystemic encephalopathy (PSE) were treated with a reduction stent. Riassunto

Safety Profile of Endovascular Treatment for Chronic Cerebrospinal Venous Insufficiency in Patients With Multiple Sclerosis

“…[5][6][7][8][9][10] The growing variety of endovascular interventions have achieved very good results as a whole, with a limited number of serious complications in treating venous thrombosis, stenosis, occlusion, compression syndromes, and arteriovenous (AV) fistulas and malformations throughout the venous system. With our established experience in venous interventions, we hypothesized that interventions on the jugular and azygos veins should not differ from the reported favorable outcomes in other veins, so in January 2010 we initiated a registry of endovascular procedures for CCSVI to establish the safety of angioplasty and stenting in the jugular and azygos veins.…”

Emergency transjugular intrahepatic portosystemic shunt (TIPS): results, complications and predictors of mortality in the first month of follow-up

“…Sin dall'ingresso in sala radiologica per tutti i pazienti sono stati monitorati i parametri vitali. Le manovre angiografiche sono state eseguite in presenza dell'anestesista rianimatore, secondo la tecnica già descritta [12]. In 65 casi è stata effettuata la puntura del ramo portale destro, in 9 casi del ramo portale sinistro ed in 8 …”

“…Monitoring the patients' vital signs was started as soon as they entered the radiological room. All angiographic manoeuvres were performed with the anaesthetist-resuscitator in attendance and according to the technique already described [12]. The right portal branch was punctured in 65 cases, the left portal branch in nine and the portal vein bifurcation in eight.…”

Perioperative considerations in patients with cirrhotic cardiomyopathy

“…Adverse outcomes usually follow procedures that require an increase in cardiac performance. At least 1% of patients with no prior history of cardiac disease who undergo a TIPS procedure will experience congestive heart failure [21 ]. This is probably caused by a sudden increase in carbon monoxide and a fall in systemic vascular resistance (SVR) immediately following TIPS insertion.…”