Transjugular intrahepatic portosystemic shunt: angiographic follow-up and secondary interventions.

Abstract

To evaluate transjugular intrahepatic portosystemic shunt (TIPS) placements and secondary interventions. Thirty shunt venograms were obtained in 21 patients with TIPS placement at 6-month intervals or if Doppler ultrasound showed an abnormality. Abnormalities in the shunt were shown in 24 venograms (80%). Eight occlusions (two early, five late, one repeat) and 16 stenoses (nine hepatic vein, six hepatic vein and stent, one stent only) were seen. Two patients with shunt abnormalities experienced recurrent bleeding. All others had no signs of recurrent portal hypertension. Occluded TIPS were recanalized (n = 5) or a new TIPS was placed parallel to the occluded one (n = 2). One repeat occlusion was not revised. Fifteen of 16 stenoses were treated successfully with balloon catheter dilation (n = 8) or additional stent placement (n = 7). The mean portal pressure gradient before revision was 21 mm Hg +/- 3.8 (standard deviation) and 13 mm Hg +/- 3.6 after revision. Stenosis and occlusion of TIPS may be common during long-term follow-up. Regular examinations may demonstrate abnormalities early. An abnormality seen on the shunt venogram usually can be revised during the same procedure.