The Transjugular Intrahepatic Portosystemic Stent-Shunt Procedure for Variceal Bleeding

• Published in: The New England journal of medicine Vol. 330; no. 3; pp. 165 - 171
• Main Authors: Rossle, Martin, Haag, Klaus, Ochs, Andreas, Sellinger, Markus, Noldge, Gerd, Perarnau, Jean-Marc, Berger, Elisabeth, Blum, Uli, Gabelmann, Andreas, Hauenstein, Karlheinz, Langer, Michael, Gerok, Wolfgang
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 20.01.1994
• Subjects: Biological and medical sciences; Bleeding; Catheters; Cirrhosis; Encephalopathy; Esophageal and Gastric Varices - mortality; Esophageal and Gastric Varices - surgery; Esophageal and Gastric Varices - therapy; Female; Flow velocity; Follow-Up Studies; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - surgery; Gastrointestinal Hemorrhage - therapy; Hemorrhage; Hepatic encephalopathy; Hepatic vein; Hepatic Veins - surgery; Humans; Hypertension; Implants; Liver cancer; Liver cirrhosis; Liver Cirrhosis - complications; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Migration; Occlusion; Portal vein; Portal Vein - surgery; Portasystemic Shunt, Surgical - adverse effects; Portasystemic Shunt, Surgical - methods; Portasystemic Shunt, Surgical - mortality; Pulmonary artery; Recurrence; Sclerotherapy; Shunts; Stenosis; Stents; Stents - adverse effects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Thrombolysis; Ultrasonic imaging; Veins & arteries; Germany; Human; Shunt; Liver; Cardiovascular disease; Hepatic disease; Hemorrhage; Vascular disease; Portal systemic; Cirrhosis; Treatment; Surgery; Portal hypertension; Digestive diseases; Technique; Varix
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM199401203300303

After experimental studies, 1 , 2 intrahepatic portosystemic shunts were established in patients by balloon dilation of tissue between portal and hepatic veins 3 , 4 . The results were disappointing, because most patients soon died with recurrent bleeding. Balloon dilation of the tissue tract was not sufficient to maintain effective portal decompression and portosystemic shunting. This problem was solved by introducing expandable stents designed to keep the shunt patent. Studies in animals 5 , 6 had demonstrated the efficacy and patency of expandable stents. Shunting with a transjugular intrahepatic portosystemic stent has been performed in patients for over five years 7 – 11 . The procedure has . . .