Transjugular intrahepatic portosystemic shunt with the Strecker stent for control of refractory acute and chronic variceal bleeding

• Published in: Scandinavian journal of gastroenterology Vol. 31; no. 3; p. 285
• Main Authors: Canizares, R B, Rodriguez-Laiz, J M, Martin, M C, Belda, A E, Alonso, F C, Roldan, F P, Castro, L S, Arregui, E C, Ricote, G C
• Format: Journal Article
• Language: English
• Published: England 01.03.1996
• Subjects: Acute Disease; Adult; Aged; Chronic Disease; Esophageal and Gastric Varices - complications; Esophageal and Gastric Varices - physiopathology; Esophageal and Gastric Varices - surgery; Female; Follow-Up Studies; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - surgery; Humans; Liver Cirrhosis - complications; Male; Middle Aged; Portal Pressure; Portasystemic Shunt, Transjugular Intrahepatic; Postoperative Complications; Prospective Studies; Recurrence; Stents
• ISSN: 0036-5521

We wanted to assess prospectively the safety, efficacy, and applicability of transjugular intrahepatic portosystemic shunt (TIPS) with the Strecker stent, focusing mainly on clinical and hemodynamic medium- and long-term follow-up. Fifty-two patients reached an indication to perform a TIPS, in an emergency or after refractory variceal bleeding. It was completed in 50 of them. All presented with cirrhosis (Child C = 15, B = 23, A = 12). The prosthesis was a Strecker stent. During the follow-up, clinical, biochemical, endoscopic, ultrasound, and pressure measurement studies were performed at 1, 3, 6, 12 months. Mean follow-up was 13.5 + or - 7.8 months. Portal pressure decreased from 32.3 + or - 8.1 (mean + or - standard deviation) to 22.3 + or - 6.7 mm Hg and portocaval gradient from 21 +/- 5.2 to 8.7 +/- 3.9 mm Hg (average, 56 + or - 16%). Shunt dysfunction was diagnosed when the portocaval gradient was >12 mm Hg (20 patients). Eleven patients (22%) presented with variceal rebleeding because of shunt dysfunction. The probability of remaining free of bleeding was 78%, 74%, and 68% at 6, 12, and 24 months, respectively. Actuarial survival rate was 91% and 86% after 12 and 18 months, respectively. TIPS with the Strecker stent is a safe alternative for variceal bleeding. Shunt dysfunction is frequent and increases the rebleeding rate, requiring a close follow-up with pressure measurements. Randomized trials comparing stents and other alternatives are needed to fully address the role of this procedure.