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The transjugular intrahepatic portosystemic Stent-Shunt (TIPSS): Results of a pilot study

CardioVascular and Interventional Radiology volume 13, pages 200–207 (1990)Cite this article

Abstract

The new concept of TIPSS (Transjugular Intrahepatic Portosystemic Stent-Shunt) using the Palmaz iliac stent was successfully accomplished in 9 patients with severe portal hypertension (7 alcoholic, 2 postinfectious liver cirrhosis) and histories of multiple life-threatening upper GI bleeding. All patients were considered noncandidates for surgical portal decompression. An intrahepatic central connection was made transjugularly between the right hepatic vein and the right portal vein in 8 patients and the left portal vein in 1. The portosystemic gradient dropped from an average of 29±7.2 mmHg to 17.8±2.9 mmHg immediately after, and to 15.7±2.8 mmHg at the latest follow-up control after the procedure. Seven patients survived the procedure and progressed to Child's A stage during the observation period of 1–10 months (mean 5 months). One patient died as a direct complication from the procedure, and another patient 11 days after the procedure from a severe nosocomial infection. In none of the surviving patients has bleeding from varices recurred or encephalopathic coma developed. In one patient the shunt diameter was moderately increased by a routine PTA catheter to further decrease the portosystemic gradient (23 to 14 mmHg) 3 months after the primary procedure. Autopsy in the two patients who died demonstrated open stent-shunts with early neoendothelial incorporation.

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Affiliations

  1. Department of Diagnostic Radiology, University Hospital Ruprecht-Karls-University, Im Neuenheimer Feld 110, 6900, Heidelberg, West Germany

    Goetz M. Richter M.D.

  2. Department of Diagnostic Radiology, University Hospital Albert-Ludwigs-University, Freiburg, West Germany

    Gerd Noeldge

  3. Department of Internal Medicine II, University Hospital Albert-Ludwigs-University, Freiburg, West Germany

    Martin Roessle

  4. Section of Interventional Radiology and Special Procedures, University of Texas Health and Science Center, San Antonio, Texas, USA

    Julio C. Palmaz

Authors
  1. Goetz M. Richter M.D.
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  2. Gerd Noeldge
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  3. Julio C. Palmaz
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  4. Martin Roessle
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Richter, G.M., Noeldge, G., Palmaz, J.C. et al. The transjugular intrahepatic portosystemic Stent-Shunt (TIPSS): Results of a pilot study. Cardiovasc Intervent Radiol 13, 200–207 (1990). https://doi.org/10.1007/BF02575474

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  • DOI: https://doi.org/10.1007/BF02575474

Key words

  • Liver cirrhosis
  • Stents, vascular
  • Hypertension, portal, interventional treatment
  • Gastrointestinal bleeding
  • Portosystemic shunt