1,000 TIPS in UH Hradec Kralove: indications and surviving

Abstract

A total of 1,000 transjugular intrahepatic portosystemic shunts were performed at the University Hospital in Hradec Králové during the period between September 1992 and February 2014. The cohort consisted of 651 males and 349 females, and the mean age was 54.9, ranging from 4.2 to 83.1 years. The procedure was most often performed in patients with liver cirrhosis dueto portal hypertension complications (927 cases) and Budd-Chiari syndrome (52 cases). The procedure was unsuccessful in five cases. The most common indications forTIPS were: stopping oesophageal or gastric bleeding which could not be terminated by other methods (196 cases), prevention of recurrent variceal bleeding (371 cases) and treatment of refractory or intractable ascites (288 cases). Complications resulting in death of the patient during the procedure occurred in five cases. One-month and one-year survival in cirrhotic patients was 88% and 67%; in patients with Child-Pugh A classification 98% and 84%; Child-Pugh B classification 92% and 67%; Child-Pugh C classification 77% and 52%; in patients with bleeding which could not be terminated by other methods it was 80% and 64%; in patients indicated to prevent rebleeding 95% and 76%; and for treatment of ascites it was 86% and 54% respectively. TIPS became a standard method for treatment of complications related to portal hypertension in cirrhotic patients. During its 21 years of use in our centre, the proportion of indications as well as the structure of the cohort of patients is gradually changing.