The aim of this prospective nonrandomized study was to asses^ the immediate and short-term sequelae of tramjugular intrahepatic portosystemic shunting on the circulatory hyperdynamic state of the cirrhotic patient. Twelve transjugular portosystemic shunting procedures were performed in 12 cirrhotic patients for sclerotherapy failure (10 cases) and/or intractable ascites (4 cases). Self-expandable stents 10 mm in diameter were wed in all cases. Portal pressure measurement and right-heart catheterization were performed before and 30 min and 1 mo after the procedure. The portoatrial pressure gradient decreased from 15 f 3 to 7 f 3 m m Hg 30 min after surgery (p c 0,0001) to 8 & 3 mm Hg 1 mo after surgery (p c 0.001, in comparison with basal values). The cardiac index increased from 4.5 & 1.3 to 5.7 f 1.5 L / d n ma 30 min after surgery (p < 0.001) to 7.4 f 1.4 L/min.m2 1 mo after surgery (p <: 0.001). Systemic vascular resistance decreased from 808 f 323 to 646 * 209 dyne * sec. cm-5 30 min after surgery (p < 0.01) to 467 * 101 dyne.sec-cm-5 1 mo after surgery (p < 0.05). This study demonstrates that transjugular portosystemic shunting rapidly and significantly worsens the hyperdynamic circulatory state of the cirrhotic patient. Although apparently noninvasive, this procedure should be considered with caution in cirrhotic patients with limited cardiac reserve. (HEPATOLOGY 1994;19:129-132.)
Transjugular intrahepatic portosystemic shunting (so-called TIPS), because of its apparent noninvasiveness, is increasingly considered as the definitive treatment for portal hypertension caused by cirrhosis, despite the fact that neither data from long-term studies nor results of prospective trials exist at present.
In our preliminary series of 32 TIPS procedures, one