Conversion of Failed Transjugular Intrahepatic Portosystemic Shunt to Distal Splenorenal Shunt in Patients With Child A or B Cirrhosis

Selim, Niazy; Fendley, Morris J.; Boyer, Thomas D.; Galloway, John R.; Branum, Gene D.

doi:10.1097/00000658-199804000-00024

Cited by 16 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…8 When a TIPS ultimately fails or cannot be revised further in a patient with well-compensated liver disease, DSRS has been used as a salvage procedure. 28 In our experience, a total of 15.3% of the patients referred for DSRS had already undergone TIPS or attempted TIPS, and several of these have been revised repeatedly. The percentage of patients who were post-TIPS increased between the former and latter parts of this study, from 11.1% to 26.7% (P=.09).…”

Section: Commentmentioning

confidence: 80%

Distal Splenorenal Shunt

Elwood

Pomposelli²,

Pomfret³

et al. 2006

Arch Surg

View full text Add to dashboard Cite

show abstract

Section: Commentmentioning

confidence: 80%

Distal Splenorenal Shunt

Elwood

Pomposelli²,

Pomfret³

et al. 2006

Arch Surg

View full text Add to dashboard Cite

show abstract

“…Four such patients in our series underwent distal splenorenal shunt after their TIPS had occluded, and we had determined these patients to be noncompliant or unsuitable candidates for transplantation. This approach has been described by Selim et al 28 who performed conversion of failed TIPS to distal splenorenal shunts in 4 patients with Child class A or B cirrhosis; however, these conversions were done for primarily technical reasons.…”

Section: Commentmentioning

confidence: 99%

Splenorenal Shunt

Lorenzo¹,

Limm²,

Wong³

2002

Arch Surg

View full text Add to dashboard Cite

Hypothesis: Splenorenal shunt, an accepted treatment to prevent recurrent variceal bleeding, is an ideal procedure for patients with psychosocial issues or limited access to tertiary medical centers. Methods:We retrospectively reviewed the medical records of 34 patients (32 distal splenorenal shunts and 2 central splenorenal shunts) treated from January 1, 1995, through December 31, 2001, for demographic data, substance abuse status, psychosocial factors, previous treatments, Child class, length of hospital stay, operative transfusions, complications, and outcome.Results: Of the 34 patients, 17 were from surrounding Pacific islands (as many as 3800 miles away from Honolulu, Hawaii). Sixteen patients were Child class A, and 18 were Child class B. Twenty-four patients were either homeless, actively involved in substance abuse, or being treated for psychiatric problems, and 20 patients were either uninsured or insured by third-party payers that did not cover liver transplantation. Four patients underwent distal splenorenal shunt for a failed transjugular intrahepatic portosystemic shunt. Patients received a mean of 1.3 U of packed red blood cells (range, 0-5 U), and 15 received no blood transfusions. Mean length of hospital stay was 12.7 days (9 days postoperatively). Perioperative mortality was 8.8%. Three patients rebled postoperatively, 2 because of gastric ulcers and 1 because of an inadequate shunt. The 1-year survival rate was 95% in the 20 patients for whom data were available.Conclusions: Splenorenal shunt is an important treatment for noncompliant patients or patients living in remote areas where access to specialized treatments, such as endoscopy, transjugular intrahepatic portosystemic shunt, ultrasonography, and liver transplantation, is limited. We can achieve acceptable morbidity and mortality in this group of patients, although follow-up can be difficult.

show abstract

“…[26][27][28] In some centers, surgical shunts are coming back into favor because of this limited TIPS patency. 29 Clearly, the conventional TIPS procedure needs to be improved. Numerous authors have described initial efforts using covered stents for TIPS procedures both experimentally 25,[30][31][32][33][34][35] and clinically.…”

Section: J Endovasc Thermentioning

confidence: 99%