Transjugular Intrahepatic Portosystemic Shunt with the Strecker Stent for Control of Refractory Acute and Chronic Variceal Bleeding Results in 50 Patients

Abstract

Background: We wanted to assess prospectively the safety, efficacy, and applicability of transjugular intrahepatic portosystemic shunt (TIPS) with the Strecker stent, focusing mainly on clinical and hemodynamic medium- and long-term follow-up. Methods: Fifty-two patients reached an indication to perform a TIPS, in an emergency or after refractory variceal bleeding. It was completed in 50 of them. All presented with cirrhosis (Child C = 15, B = 23, A = 12). The prosthesis was a Strecker stent. During the follow-up, clinical, biochemical, endoscopic, ultrasound, and pressure measurement studies were performed at 1, 3, 6, 12 months. Mean follow-up was 13.5 ± 7.8 months. Results: Portal pressure decreased from 32.3 ± 8.1 (mean ± standard deviation) to 22.3 ± 6.7 mm Hg and portocaval gradient from 21 ± 5.2 to 8.7 ± 3.9 mm Hg (average, 56 ± 16%). Shunt dysfunction was diagnosed when the portocaval gradient was >12 mm Hg (20 patients). Eleven patients (22%) presented with variceal rebleeding because of shunt dysfunction. The probability of remaining free of bleeding was 78%, 74%, and 68% at 6, 12, and 24 months, respectively. Actuarial survival rate was 91% and 86% after 12 and 18 months, respectively. Conclusion: TIPS with the Strecker stent is a safe alternative for variceal bleeding. Shunt dysfunction is frequent and increases the rebleeding rate, requiring a close follow-up with pressure measurements. Randomized trials comparing stents and other alternatives are needed to fully address the role of this procedure.

Key Words:

• Esophagus
• varices
• gastrointestinal bleeding
• hypertension
• portal
• shunts
• portosystemic
• Strecker stent