Brief Article
Copyright ©2012 Baishideng Publishing Group Co.
World J Hepatol. Feb 27, 2012; 4(2): 35-42
Published online Feb 27, 2012. doi: 10.4254/wjh.v4.i2.35
Table 1 Patient characteristics and clinical results
PatientSex, age (yr)Underlying conditionIndication for TIPSPrevious treatmentChild pugh scoreMELD scoreSurvival post shuntComplications and follow-up
1F (76)Hepatitis BHydrothorax, refractory ascitesNumerous thoracenteses, furosemideB (9)925 mo, expiredtransient encephalopathy (grade 1 to 2) 1 episode < 30 d, 6 episodes over 24 mo, pulm, edema x 1
2M (78)Celiac sprueRefractory ascitesNumerous paracenteses, spironolactoneC (10)741 mo, expiredEncephalopathy (grade 1 to 2) > 30 d 6 episodes over 40 mo
3M (71)Cryptogenic cirrhosisRefractory ascitesNumerous paracenteses, spironolactoneB (8)168 mo, expiredNone
4F (80)Cryptogenic cirrhosisHepatic hydrothoraxNumerous thoracenteses, spironolactoneC (11)113.5 mo, expiredEncephalopathy transient grade 1 (2 episodes at 30 d and 3 mo)
5M (69)Sclerosing cholangitisRefractory ascitesNumerous paracenteses, spironolactoneC (12)173 mo, expired post attempted shuntNone
6M (65)Alcoholic cirrhosisHepatic hydrothoraxNumerous thoracenteses, spironolactone, lasixB (9)1519 mo liver transplant, still aliveEncephalopathy transient grade 1 (1 episode > 30 d and < 3 mo)
7M (71)Alcoholic cirrhosisRefractory ascitesNumerous paracenteses, spironolactone, lasixC (10)133 mo, expiredEncephalopathy transient grade 1 (3 episodes > 30 d)
8F (70)Hepatitis CRefractory ascites, skin breakdownNumerous paracenteses, spironolactone, lasixB (8)92nd TIPS placed at 21 mo due to occlusion of 1st TIPS expired 47 mo post initial TIPSNone
9F (66)Hepatitis CAcute bleedingB (7)9Lost to fu pt in SpainNone
10F (72)CryptogenicAcute bleeding, refractory ascitesParacentesis, propanolol, lactulose, protonixB (9)1210 mo lost to fuNone
11F (72)Hepatitis CAcute bleedingSclerotherapy, spleno-renal shunt × 2, numerous paracentesis, lasix, spironolactoneB (8)9Liver transplant 18 mo after TIPS, still aliveNone
12F (67)Hepatitis B portal vein thromboisAcute bleedingOctreotide, protonixC (10)10Liver transplant 16 mo after TIPS, still aliveNone
13M (74)Hepatitis C (end stage liver disease)Refractory ascitesAldactone, lasix, lactulose, protonixB (8)152 wk, expiredTransient encephalopathy grade 1 (< 2 wk)
14F (68)Hepatitis CAcute bleedingMidodrineB (7)242 mo, expiredRecurrent GI bleed 3 wk required revision
15M (69)CryptogenicAcute bleeding4 unsuccessful banding, lasix, spironolactone, lactulose, paracentesisC (10)21Revision required 48 h after liver transplant 11 mo after revision, still aliveContinued bleed after 1st TIPS, stopped after revision
16F (73)NASH cirrhosisAcute bleedingOctreotide, protonix, spironolactone, lasixB (9)1125 mo, still aliveMinimal ascites
17M (71)CryptogenicAcute bleedingBand ligation-not successfulB (8)16Lost to fuNone
18M (82)CryptogenicRefractory ascites, acute bleedingNumerous paracentesis, lasix, amilorideB (9)162 wk expired (AV block-DNR/DNI )None
19M (73)Hepatitis CRefractory ascitesNumerous paracenteses, Spironolactone, lasix s/p kidney and liver txB (9)141 mo lost to fuNone
20F (78)Hepatitis CAcute bleeding, refractory ascitesB (8)185 d, expiredPost-procedural bleeding, encephalopathy (< 30 d), ascites
21M (71)CirrhosisAcute bleedingB (8)11Status unknown, discharged to rehabilitation hospitalNone
22M (66)Alcoholic cirrhosis, s/p liver transplant, portal vein thrombosisRefractory ascitesLasixB (9)8UnknownFailed attempted TIPS
23M (76)Alcoholic cirrhosisRefractory ascitesNumerous paracenteses (once a week)B(8)1215 mo, still aliveNone
Table 2 Technical details and results
PatientProcedure time (min)SuccessNo. of stentsStent type (mm)Balloon size (mm)Portosystemic gradient (mmHg)Revision dates
1150Yes210 × 68106-9
2160Yes210 × 6888
Revision 2165Yes112 × 90105Revision 3 wk
Revision 2105Yes112 × 901010-12Revision 8 mo
Revision 290Yes112 × 90106-8Revision 32 mo
3140Yes112 × 90103-4
465Yes110 × 9483-5
6165Yes110 × 601812
7235Yes110 × 701813
8135Yes28 × 601812
Revision 8120Yes28 × 61810New Parallel TIPS 21 mo
915Yes18 × 70185
10UnavailableYes110 × 801107
Revision 1050Yes1UnavailableUnavailableUnavailableRevision 10 mo
1150Yes210 × 8011010
1270Yes110 × 801104
13150Yes110 × 801103
1435Yes110 × 601106
Revision 14UnavailableYes1UnavailableUnavailableUnavailableRevision 3 wk
1535Yes110 × 7011013
Revision 1518Yes1UnavailableUnavailableUnavailableRevision 48 h
1655Yes110 × 801102
1765Yes110 × 801108
1830Yes110 × 801104
1985Yes210 × 601104
Revision 19UnavailableYes112 × 60110UnavailableUnavailable
20UnavailableYes110 × 80184
21UnavailableYes18 × 80182
23135Yes110 × 70188
Table 3 Comorbidites
1Hypothyroidism, diabetes mellitus, hypertension, chronic GI bleed, hypoxemia on home oxygen
2Celiac sprue, recurrent chronic bleeding from esophageal varices
3Congestive heart failure, s/p CABG, s/p mitral valve replacement, chronic atrial fibrillation, hypertension
4Aortic stenosis
5Noninsulin dependent diabetes mellitus, chronic renal failure, cholecystectomy, bilateral hernia repair
10Status post lumpectomy, diabetes type 2, basal cell carcinoma of the skin, some masculinizing tumor of the ovary for which the patient has had a bilateral salpingo-oopherectomy, hypertension
11Cholecystectomy, diabetes mellitus
12Breast cancer in 1996 status post modified radical mastectomy, history of portal vein thrombosis in 2002 secondary to tamoxifen
13Aortic stenosis; coronary artery disease, status post 3-vessel CABG; diabetes mellitus; and bilateral lower extremity cellulitis.
14End-stage renal, diabetes, GERD, diverticulitis
16Coronary artery disease (CAD), hyperlipidemia, Anemia
17Peptic ulcer disease, obstructive sleep apnea, gastroesophageal reflux disease, myeloproliferative disorder, diabetes, aortic stenosis, status post aortic valve replacement in 1996, coronary artery disease
18Severe aortic stenosis, chronic renal insufficiency, BPH, sinus bradycardia with mobitz type I AV block
19Renal failure, status post transplant, cryoglobulinemia, BPH, hypothyroidism
20Hypothyroid, coagulopathy
21Prostate cancer, CHF, AFib, COPD, hypertension, CVA, respiratory failure, history of MRSA and VRE
22Spontaneous bacterial peritonitis, status post liver transplant, hypertension, diabetes, portal vein thrombosis
23CAD, hiatal hernia