Transjugular intrahepatic portosystemic shunts (TIPS) in children

• Published in: The Journal of pediatrics Vol. 131; no. 6; pp. 914 - 919
• Main Authors: Heyman, Melvin B., LaBerge, Jeanne M., Somberg, Kenneth A., Rosenthal, Philip, Mudge, Christine, Ring, Ernest J., Snyder, John D.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.12.1997; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Chronic Disease; Diseases of the digestive system; Equipment Design; Esophageal and Gastric Varices - complications; Female; Follow-Up Studies; Gastrointestinal Hemorrhage - complications; Humans; Hypertension, Portal - complications; Hypertension, Portal - surgery; Male; Medical sciences; Portasystemic Shunt, Transjugular Intrahepatic - adverse effects; Portasystemic Shunt, Transjugular Intrahepatic - instrumentation; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Reoperation; Retrospective Studies; Thrombocytopenia - complications; Vascular Patency; TIPS; Human; Jugular vein; Prognosis; Portal circulation disease; Shunt; Instrumentation therapy; Cardiovascular disease; Highway access road; Vascular disease; Treatment; Portocaval; Portal hypertension; Digestive diseases; Complication; Intrahepatic; Technique; Child
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(97)70043-X

The transjugular intrahepatic portosystemic shunt procedure is an accepted treatment for adults with complications of portal hypertension. We performed a retrospective review of all pediatric TIPS placements performed at the University of California, San Francisco between 1990 and 1996. Twelve procedures were attempted in nine children, with a mean age (± SD) of 9.4 ± 3.9 years (range, 5 to 15 years) and a mean weight of 31 ± 18 kg (range, 16 to 70 kg). The indications for TIPS placement were portal hypertension complicated by chronic variceal hemorrhage not controlled with sclerotherapy ( n = 7) and hypersplenism with thrombocytopenia ( n = 2). TIPS placement was successfully completed initially in seven of nine (78%) patients. Unfavorable vascular anatomy was the cause of failure in two cases. The seven patients who underwent successful TIPS placement were followed up for an average of 136 days (range, 1 to 800 days); two still have patent shunts, three underwent liver transplantation, one had a splenorenal shunt after stenosis, and one died of underlying liver disease. Variceal bleeding was controlled in four of five patients who successfully underwent TIPS placement. Shunt occlusion occurred in four patients; patency was restored by transjugular shunt revision in three, and a splenorenal shunt was performed in one. (J Pediatr 1997;131:914-9) See editorial, p. 798.