J Korean Radiol Soc.  1992 Jun;28(3):393-398.

Transjugular intrahepatic portsystemic shunt

• Park JH
• Han JK
• Chung JW
• Han MC

Abstract

As a new interventional procedure for the control of variceal bleeding, a portosystemic shunt can be established with the installment of metallic stent through the transjugular approach. In order to evaluate the clinical usefulness of the procedure, transjugular intrahepatic portosystemic chunt procedure were performed in 5 patients with variceal bleeding due to liver cirrhosis. The metallic stents were mainly a self expandable Wallstent(Schneider, Switzerland). An 8 to 10 mm shunt was formed by the insertion of the stent and balloon dilatation after puncture of the proximal portal vein from the right or middle hepatic vein. The patency of the shunt was proven by portography after the procedure. The portal pressure measured in 3 patients before and after the procedure improved with decrease from 31 mmHg to 25 mmHg. The procedure failed in 1 patient due to preexsisting portal vein thrombosis. During the follow-up period from 1 month to 4 months, shunts were patent in all 4 patients. However, hepatic encephalopathy occured in one patient one week following the procedure. Though the follow-up period was not long enough for full evaluation. We found the transjugular intrahepatic portosystemic shunt was a safe and effective procedure for the control of variceal bleeding by lowering the portal pressure. For the appropriate application for this procedure, the optimal size of the shunt and optimal degree of the resultant decompression are yet to be determined in the future.

MeSH Terms

Decompression
Dilatation
Esophageal and Gastric Varices
Follow-Up Studies
Hepatic Encephalopathy
Hepatic Veins
Humans
Liver Cirrhosis
Portal Pressure
Portal Vein
Portasystemic Shunt, Surgical
Portography
Punctures
Stents
Venous Thrombosis