0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Using Transjugular Intrahepatic Portosystemic Shunts to Control Variceal Bleeding before Liver Transplantation

Ernest J. Ring, MD; John R. Lake, MD; John P. Roberts, MD; Roy L. Gordon, MD; Jeanne M. LaBerge, MD; Alexandra E. Read, MD; Martina R. Sterneck, MD; and Nancy L. Ascher, MD
[+] Article and Author Information

Requests for Reprints: Ernest J. Ring, MD, University of California, San Francisco, Box 0628, San Francisco, CA 94143.

Current Author Addresses: Drs. Ring, Gordon, and Laberge: University of California, San Francisco, Box 0628, San Francisco, CA 94143. Drs. Lake, Roberts, Sterneck, and Ascher: University of California, San Francisco, Box 0780, San Francisco, CA 94143.

Dr. Read: Overtake Internal Medicine Associates, 1011 116th Avenue, NE, Bellevue, WA 98004.


©1992 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1992;116(4):304-309. doi:10.7326/0003-4819-116-4-304
Text Size: A A A

Objective: To determine the safety and efficacy of transjugular intrahepatic portosystemic shunts (TIPS) in controlling bleeding from esophageal varices in patients awaiting liver transplantation.

Design: Prospective, uncontrolled trial.

Setting: University medical center with an active liver transplant program.

Patients: Thirteen patients referred for liver transplantation with either active variceal hemorrhage or recurrent variceal hemorrhage despite sclerotherapy; four patients had been previously treated with surgical portosystemic shunts.

Intervention: An intrahepatic portosystemic shunt created via a transjugular approach to the hepatic veins using expandable, flexible metallic stents.

Measurements: Portal pressures before and after the creation of the shunt, the direction of portal blood flow at differing diameters of the shunts, procedure-related complications, and outcome in terms of survival, liver transplantation, and recurrent variceal bleeding.

Main Results: The transjugular intrahepatic portosystemic shunt was placed successfully in 13 patients, and bleeding was controlled acutely in all 13. After the procedure, the mean portal pressure decreased from 34 ± 8.9 cm H2O to 22.4 ± 5.4 cm H2O (P < 0.001). No complications were associated with the procedure; however, two patients died of causes unrelated to the procedure. Seven patients subsequently underwent liver transplantation and are doing well, and three patients are being managed conservatively. Bleeding recurred in one patient 102 days after the procedure secondary to shunt occlusion caused by neointimal proliferation.

Conclusion: Placement of a transjugular intrahepatic portosystemic shunt is apparently safe and effective therapy for variceal hemorrhage in patients referred for liver transplantation.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)