Complications following transjugular intrahepatic portosystemic shunt: a retrospective analysis

• Published in: Transplantation proceedings 2004-05, Vol.36 (4), p.926-928
• Main Authors: Silva, R.F, Arroyo, P.C, Duca, W.J, Silva, A.A.M, Reis, L.F, Cabral, C.M, Sgnolf, A, Domingues, R.B, Barao, G.T.F, Coelho, D.J, Deberaldini, M, Felı́cio, H.C.C, Silva, R.C.M.A
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cause of Death; Female; Humans; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical Records; Medical sciences; Middle Aged; Portasystemic Shunt, Transjugular Intrahepatic - adverse effects; Portasystemic Shunt, Transjugular Intrahepatic - mortality; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Failure
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2004.03.117

Transjugular intrahepatic portosystemic shunt (TIPS) has been the therapeutic option for severe decompensation of chronic liver disease and as a bridge to liver transplantation. The aim of this study was to analyze the complications of this procedure. The records of 47 patients (39 men) of mean age 48 years underwent TIPS procedures from 1998 to 2003 were reviewed. Forty-one patients received 45 successful TIPS; it failed in six patients. Improvement was observed in 20 of 28 patients with upper gastrointestinal bleeding (71%); 9 of 11 with ascites (82%); and 5 of 8 with impaired renal function (62%). The Child-Pugh scores improved in 6 of the 47 patients (13%). Transplantation was performed in 11 patients (23%). The complications were: encephalopathy (49%); infection (19%); renal failure (17%); TIPS migration to the portal vein (4%) and to the right atrium (4%). Mortality was 32% (15/47) over 3 months. Eight patients developed active bleeding during TIPS installation requiring mechanical ventilation and intensive care, and died within the first week. Other causes of death were sepsis ( n = 2), liver failure ( n = 1), accidental puncture of the Glisson's capsule leading to intra-abdominal bleeding ( n = 1) and refractory upper gastrointestinal bleeding ( n = 3). The latter four patients had TIPS placement failure. In conclusion, TIPS produced clinical improvement among 51% of patients with complications in 49%. The main complications were encephalopathy (49%), infection (19%), and renal failure (17%). The 3-month mortality rate after TIPS placement was 32%.