Usefulness of Transjugular Intrahepatic Portosystemic Shunt in the Management of Bleeding Ectopic Varices in Cirrhotic Patients
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To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the control of bleeding from ectopic varices.
From 1995 to 2004, 24 cirrhotic patients, bleeding from ectopic varices, mean age 54.5 years (range 15–76 years), were treated by TIPS. The etiology of cirrhosis was alcoholic in 13 patients and nonalcoholic in 11 patients. The location of the varices was duodenal (n = 5), stomal (n = 8), ileocolic (n = 6), anorectal (n = 3), umbilical (n = 1), and peritoneal (n = 1).
TIPS controlled the bleeding in all patients and induced a decrease in the portacaval gradient from 19.7 ± 5.4 to 6.4 ± 3.1 mmHg. Postoperative complications included self-limited intra-abdominal bleeding (n = 2), self-limited hemobilia (n = 1), acute thrombosis of the shunt (n = 1), and bile leak treated by a covered stent (n = 1). Median follow-up was 592 days (range 28–2482 days). Rebleeding occurred in 6 patients. In 2 cases rebleeding was observed despite a post-TIPS portacaval gradient lower than 12 mmHg and was controlled by variceal embolization; 1 patient underwent surgical portacaval shunt and never rebled; in 3 patients rebleeding was related to TIPS stenosis and treated with shunt dilatation with addition of a new stent. The cumulative rate of rebleeding was 23% and 31% at 1 and 2 years, respectively. One- and 2-year survival rates were 80% and 76%, respectively.
The present series demonstrates that bleeding from ectopic varices, a challenging clinical problem, can be managed safely by TIPS placement with low rebleeding and good survival rates.
KeywordsEctopic varices Portal hypertension Trans- jugular intrahepatic portosystemic shunt
- 5.Lafortune M, Martinet JP, Denys A, et al. (1995) Short- and long-term hemodynamic effects of transjugular intrahepatic portosystemic susnts: A Doppler/manometric correlative study. AJR Am J Roentgenol 164:997–1002Google Scholar
- 6.Hosking SW, Smart HL, Johnson AG, et al. (1989) Anorectal varices, hemorrhoids and portal hypertension. Lancet I:349–352Google Scholar
- 7.Kinkhabwala M, Mousavi A, Iyer S, et al. (1977) Bleeding ileal varicosity demonstrated by transhepatic portography. AJR Am J Roentgenol 129:514–516Google Scholar
- 10.Handschin AE, Weber M, Weishaupt D, et al. (2002) Contrast-enhanced three-dimensional magnetic resonance angiography for visualization of ectopic varices. Dis Col Rectum 45:1541–1544Google Scholar
- 15.Hidajat N, Stobb H, Hosten N, et al. (2002) Transjugular intrahepatic shunt and transjugular embolization of bleeding rectal varices in portal hypertension. AJR Am J Roentgenol 178:362–363Google Scholar
- 23.Shibata D, Brophy DP, Gordon FD, et al. (1999) Transjugular intrahepatic portosystemic shunt for treatment of bleeding ectopic varices with portal hypertension. Dis Col Rectum 42:1581–1585Google Scholar