Patient Selection, Outcome and Clinical Efficacy of TIPS: A Single Center Experience and Review of the Literature

Abstract

Background/Aim: Transjugular intrahepatic portosystemic shunt (TIPS) is known to be an efficient procedure for decompression of portal hypertension and control of consecutive complications. We analyzed our experience with the efficacy and complications of the procedure in a variety common and uncommon indications. Methods : In this single center retrospective analysis, 38 patients with different symptoms complicating portal hypertension, including portal vein thrombosis and non-variceal GI-bleeding, were treated by TIPS. Treatment was performed in conscious sedation and guided by ultrasonography and fluoroscopy, using polytetrafluorethylene-covered stents. Results: The rate of technically successful interventions was 98%. All shunts were patent during the follow up period of 36 months. The clinical disorders leading to TIPS implantation, such as ascites and variceal bleeding were successfully treated in all cases. The most frequent complication was transient encephalopathy (40%). TIPS dysfunction with reoccurrence of initial symptoms was noted in 39%, and treated successfully in all cases. 8/38 patients died during the follow up period, mostly due to progressive deterioration of liver function or to non-hepatic reasons. Conclusion : In conclusion, this study confirms TIPS to be a safe and effective procedure for treatment of different complications associated to portal hypertension. Our results as well as a review of the current literature suggest TIPS to be the standard treatment in patients with refractory ascites and Budd-Chiari syndrome, and to be of emerging significance in the management of portal thrombosis. In addition, TIPS maybe of value in new indications, such as obscure non-variceal bleeding associated with portal hypertension.