![]() All patients with cirrhosis over the age of 18 years who received a PTFE-covered TIPS were included. Specific markers were evaluated for early and long-term mortality in patients with TIPS placement for refractory ascites or variceal bleeding.ĭata of electronic health records of patients who underwent a TIPS placement in the Amsterdam University Medical Center, location Academic Medical Centre (AMC) between October 2001 and November 2016 were collected in a database. The aim of this study was to assess the indications, survival, clinical outcome and yield, and usefulness of Doppler ultrasound for predicting TIPS failure at 3, 6, and 12 months after PTFE-covered TIPS placement in a single-centre academic cohort. The hepatologist sees the patient one month after TIPS placement to start lowering diuretics, and after each Doppler US study. 6 At our institution, patients undergo Doppler US at day 5-7 after TIPS placement, followed by Doppler US at 3, 6, and 12 months, and subsequently every 12 months. American Association for the Study of Liver Diseases (AASLD) guidelines advise hospitals to have an established program for surveillance, but no specific intervals are suggested. Currently, TIPS patients stay under close surveillance in most centres to monitor patency of the shunt with Doppler ultrasound (US) with assessment of blood flow through the shunt. Furthermore, there is no consensus regarding follow-up after TIPS placement. 7 However, MELD does not predict post-TIPS complications like the development of HE. The Model for End-stage Liver Disease (MELD) was initially developed to differentiate between patients who might benefit from TIPS and those who might not. There are few well-established prognostic markers that predict outcome after TIPS placement. 6 However, patients often need hospital admission to undergo treatment. 4,5 This complication can be treated in 95% of the cases with drug therapy. 2,3 Still, post-TIPS HE is a common (15-54%) complication that requires attention. 1 Since the introduction of polyfluor-ethylene (PTFE)-covered stents, patency has increased and the rates of stent thrombosis and in-stent stenosis have decreased drastically. Placement of a transjugular intrahepatic portosystemic shunt (TIPS) is a highly effective intervention to reduce the portal pressure and to prevent rebleeding or treat refractory ascites. Most frequent complications of portal hypertension are bleeding of oesophageal or gastric varices, (refractory) ascites, and hepatic encephalopathy (HE). Liver cirrhosis represents the late stage of chronic liver disease and is associated with portal hypertension (PH). ![]()
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