[Transjugular intrahepatic portacaval shunt. Preliminary results].

Abstract

Transjugular implantation of a metallic prosthesis between main portal branch and a hepatic vein is a new intrahepatic portosystemic shunt method to treat portal hypertension. Forty-nine cirrhotic patients with portal hypertension were treated using this technique. The success rate of implantation was 94%. Mortality due to the procedure was 2%. Early complications decreased with the operator's learning curve consisting of bleeding (20%): digestive hemorrhage (n = 5; 12%), hemobilia (n = 4; 8%), which ceased after withdrawal of post-operative heparin. Early thrombosis following shunt implantation occurred in 13% of the patients. Shunt implantation resulted in a 53 +/- 16% decrease in the portocaval pressure gradient (21 +/- 5 to 10 +/- 4 mmHg). Shunts were performed in 45 patients to prevent a recurrence of variceal bleeding. Follow-up of 41 patients showed 12.2% with variceal rebleeding and 16 patients (39%) with a stenosis requiring a redilation. Ascites improved in 95% of the patients and hepatic encephalopathy occurred in 17%. One year survival was 85%. Controlled studies are needed to determine the indications of this new treatment for ascites and bleeding.

• Authors: J M Perarnau, J J Raabe, D Schwing, B Rucin, S Monchovet, M Rössle, J Arbogast
• Journal: Gastroenterologie clinique et biologique (Gastroenterol Clin Biol) Vol. 17 Issue 6-7 Pg. 422-30 ( 1993) ISSN: 0399-8320 [Print] France
• Vernacular Title: Anastomose porto-cave intra-hépatique par voie transjugulaire. Résultats préliminaires.
• PMID: 8243926 (Publication Type: Journal Article)

Topics

• Actuarial Analysis
• Adult
• Aged
• Aged, 80 and over
• Ascites (etiology, surgery)
• Budd-Chiari Syndrome (etiology)
• Esophageal and Gastric Varices (blood, complications, diagnostic imaging)
• Female
• Follow-Up Studies
• Gastrointestinal Hemorrhage (blood, diagnostic imaging, etiology, prevention & control)
• Humans
• Hypertension, Portal (complications)
• Liver Cirrhosis (complications)
• Liver Cirrhosis, Alcoholic (complications)
• Male
• Middle Aged
• Portacaval Shunt, Surgical (adverse effects, methods, mortality)
• Postoperative Complications
• Radiography
• Recurrence
• Ultrasonics