Hepatic Perfusion before and after the Transjugular Intrahepatic Portosystemic Shunt Procedure: Impact on Survival
Section snippets
MATERIALS AND METHODS
From 1995 to 1997, we evaluated 34 potential TIPS patients with nuclear medicine flow studies. Fortythree patients underwent a TIPS procedure during this interval but we excluded nine patients who had TIPS performed emergently or during the evening hours or weekends. Seven additional patients were excluded from the study population for other reasons. Four had unsuccessful TIPS procedures (all with chronic portal vein thrombosis) and one patient was excluded because of Budd-Chiari syndrome.
RESULTS
Seventeen patients died of progressive liver failure (63% of patients), occurring between 4 days and 22 months after the procedure (mean, 6.2 months). The remaining 10 patients were followed clinically and by means of ultrasound shunt surveillance for 27–45 months (mean, 37 months). The breakdown of arterial versus portal flow revealed significant differences between patients with cirrhosis, patients with cirrhosis after TIPS, and normal control subjects. The mean hepatic arterial contribution
DISCUSSION
Currently, TIPS is accepted treatment for variceal hemorrhage that has failed to respond to endoscopic therapy. A more recent indication is medically refractory ascites, and active research is hinting that TIPS may be a viable option in hepatorenal syndrome (16) and as primary therapy in portal hypertension complicated by bleeding (17). As indications broaden, increasing numbers of cirrhotic patients will be subjected to TIPS. Accordingly, methods to identify high-risk patients become quite
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