11 year experience of Transhepatic Porto-systemic Shunt
Control/Tracking Number: 04-P-1707-ECRActivity: Scientific Paper (talk : 7min.+ 2min. discussion)
Transjugular intrahepatic portosystemic shunting (TIPSS): Eleven year experience in a regional referral centre
Author Block: S.B. Babu, M. Nayar, R. Saravanan, P. Rowlands, R. McWilliams, H. Smart, M. Lombard; Liverpool/GB
Abstract: Background: Since the introduction of TIPSS in 1988 it has been widely promoted as a treatment for uncontrolled variceal bleeding and refractory ascites. There are few long term follow-up studies.
Aims and Methods: This retrospective analysis was to study the efficacy of TIPSS and to look at five year survival. We assessed the effect of Childs Pugh grade, previous management, intervals of referral, complications and mortality.
Results: 124 patients had 148 procedures performed during the study period. Mean age was 51.5 years (range 18-87 years) and 59% were male. Portal hypertension was caused by alcoholic liver disease in 81% with viral hepatitis B/C being an additional etiology in 11 (12%) of these patients. 92% of patients presented with variceal bleeding (esophageal, gastric, rectal or stomal) while the rest were patients with refractory ascites. The Childs Pugh score of the patients was A = 13%, B = 24% and C = 63%. 38 patients (33%) had 46 episodes of re-bleeding at a mean interval of 134 days after the procedure (range 1-780 days). 25 (66%) of the patients who re-bled had a repeat TIPSS performed. 72 (62%) patients have died over the follow-up period. Of the patients who died, recurrent bleeding was the cause of death in 16 (22%) whilst multi-organ failure was the most common mode of death (70%).
Conclusion: TIPSS is an effective procedure in controlling variceal bleeding. Multi-organ failure is the most common cause of death in this mainly alcohol-related patient group. Mortality rates remain high in Child C patients.
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Topic (Complete): Interventional Radiology
Presentation/AV (Complete):
I understand that only digital projection material will be allowed. : Yes
This abstract is related to emergency radiology. : Yes
Status: Complete