The natural history of portal hypertension after transjugular intrahepatic portosystemic shunts

A. J. Sanyal, Arthur M. Freedman, V. A. Luketic, P. P.III Purdum, M. L. Shiffman, J. Demeo, P. E. Cole, J. Tisnado

Research output: Contribution to journalArticle

Abstract

Background and Aims: The effects of trans jugular intrahepatic portosystemic shunt (TIPS) on portal hemodynamics, esophageal and gastric varices, and hepatic function have not been fully defined. The aim of this study was to define prospectively the effects of TIPS on portal pressures and flow, variceal resolution, and hepatic function. Methods: Pressure and flow measurements were made by angiography and Doppler sonography, respectively. Varices were assessed by endoscopy and angiography. Liver functions were evaluated by a battery of tests. Results: In 100 consecutive subjects, mean portosystemic gradient decreased from 24 to 11 mm Hg (means) (P < 0.001) after TIPS. Recurrent portal hypertension caused by stent thrombosis (n = 5), stent retraction (n = 2), and stent stenosis (n = 51) occurred at 6 months but, by year 5, was not present in survivors (n = 0 of 8). Fundic gastric varices failed to resolve in 6 of 12 cases. Systemic venous pressures of >15 mm Hg, stent dysfunction, and continued alcoholism were risk factors for recurrent hemorrhage. Angiography was superior to endoscopy, which was superior to Doppler sonography for detection of recurrent portal hypertension. Progressive liver failure occurred in 8 patients. Conclusions: Recurrent portal hypertension caused by stent stenosis occurs commonly in the first 2 years after TIPS. Fundic gastric varices often fail to disappear after TIPS. The effects of TIPS on liver function are unpredictable.

Original languageEnglish (US)
Pages (from-to)889-898
Number of pages10
JournalGastroenterology
Volume112
Issue number3
DOIs
StatePublished - Jan 1 1997
Externally publishedYes

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Surgical Portasystemic Shunt
Transjugular Intrahepatic Portasystemic Shunt
Portal Hypertension
Neck
Doppler Ultrasonography
Angiography
Esophageal and Gastric Varices
Liver
Endoscopy
Stents
Portal Pressure
Liver Failure
Varicose Veins
Alcoholism
Pathologic Constriction
Hemodynamics
Hemorrhage
Pressure

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Sanyal, A. J., Freedman, A. M., Luketic, V. A., Purdum, P. P. III., Shiffman, M. L., Demeo, J., ... Tisnado, J. (1997). The natural history of portal hypertension after transjugular intrahepatic portosystemic shunts. Gastroenterology, 112(3), 889-898. https://doi.org/10.1053/gast.1997.v112.pm9041251

The natural history of portal hypertension after transjugular intrahepatic portosystemic shunts. / Sanyal, A. J.; Freedman, Arthur M.; Luketic, V. A.; Purdum, P. P.III; Shiffman, M. L.; Demeo, J.; Cole, P. E.; Tisnado, J.

In: Gastroenterology, Vol. 112, No. 3, 01.01.1997, p. 889-898.

Research output: Contribution to journalArticle

Sanyal, AJ, Freedman, AM, Luketic, VA, Purdum, PPIII, Shiffman, ML, Demeo, J, Cole, PE & Tisnado, J 1997, 'The natural history of portal hypertension after transjugular intrahepatic portosystemic shunts', Gastroenterology, vol. 112, no. 3, pp. 889-898. https://doi.org/10.1053/gast.1997.v112.pm9041251
Sanyal, A. J. ; Freedman, Arthur M. ; Luketic, V. A. ; Purdum, P. P.III ; Shiffman, M. L. ; Demeo, J. ; Cole, P. E. ; Tisnado, J. / The natural history of portal hypertension after transjugular intrahepatic portosystemic shunts. In: Gastroenterology. 1997 ; Vol. 112, No. 3. pp. 889-898.
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