Transjugular intrahepatic portosystemic shunt ; Experimental and clinical study

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Experimental study : An experimental swine model with acute presinusoidal portal hypertension was used to investigate the fisibility of a Z-stent for transjugular intrahepatic portosystemic shunt and the correlation between the shunt size and degree of portal pressure decrease. Twelve young swine were used. Acute portal hypertension was indused by selective injections of absolute ethanol, Ethiodol, and Ivalon into intrahepatic portal branches. TIPS was successfully created in all swineusing Z-stent, 6,8, and 10mm in deameter, each size in 4 animals. Being sufficiently flexible, Z-stents accommodated for curved shunt tracks. An average of 48% portal pressure decrease was achieved with 6mm diameter stents, 64% with 8 mm diameter stents and 89% with 10 mm diameter stents. These results are in agreement with our clinical experience using Gianturuco-Rosch Z-stents for TIPS formation.Clinical study : TIPS was created in nine patients with hepatoma (Child class A=3, B=2, C=4). 7 of 9 patients had been treated hepatomas by embolotherapy and/or percutaneous ethanol injection, whic were well controlled. Technical success was 100% without procedure-related complication. Thirty-day mortality rate was 0%.All of 5 variceal hemorrhage arrested immediately after successful of TIPS,and uncontrollable ascites was dissapeared in 3 and no change in 2. TIPS creation is a safe and effective method of portal venous decompression in the management of variceal bleeding and ascites even for the patients with hepatoma.