Abstract
The long-term clinical results of transjugular intrahepatic portosystemic shunt (TIPS) were investigated, mainly in patients undergoing the treatment at our hospital. TIPS reduced the portal venous pressure by about 50%, achieving the control of esophageal variceal bleeding in more than 95% of the patients. More than 10% of the patients developed complications other than hepatic encephalopathy. Although this rate was relatively low, complications related to vascular injury were lethal in some cases. Although this procedure has little effect on liver function, there is a possibility of liver failure occurring in patients with advanced liver dysfunction. The effect on esophageal varices and ascites depends on the function of the shunt. During follow-up, the shunt eventually failed in 40 to 70%. Although this failure rate is relatively high, function could be restored by percutaneous transluminal angioplasty (PTA). It is essential to detect a stenosis or obstruction at an early stage by color doppler ultrasonography (CDUS) or other methods. Regarding the long-term prognosis, patients who survived the longest were alive 6 years after TIPS. The 1-, 3-, and 5-year survival rates were approximately 70%, 60%, 40%, respectively. Only a few patients require liver transplantation after TIPS in Japan. In Europe and the United States, about 30% undergo liver transplantation. TIPS may be the treatment of choice for patients with intractable esophago-gastric varices or refractory ascites. When this procedure is indicated, the potentially lethal complications should be carefully taken into consideration.
