Abstract
The purpose of this study was to evaluate the short-term splanchnic and systemic hemodynamics and hepatic function after TIPS creation. Fifteen cirrhotics with portal hypertension underwent TIPS placement for treatment of variceal hemorrhage, and extensive hemodynamic studies including right heart catheterization, portal pressure measurement, hepatic blood flow, and indocyanine green (ICG) clearance were performed before and 1 month after the procedure. Self-expandable metal stents (Strecker 11 mm diameter) were placed in all cases. Portasystemic gradient significantly diminished (18.3±4.2 vs 8±2.8; 54%±18 mm Hg) after the technique, mainly due to a decrease in portal pressure, and remained stable in the final study. Cardiac output and mean arterial pressure increased (6.2±1.4 vs 8.2±1.8 liters/min, 80.1±10.1 vs 91±11.2 mm Hg, respectively), and a decrease in systemic vascular resistance was registered (1018±211 vs 872±168 dyne/sec/cm5); the hepatic blood flow and ICG clearance also decreased significantly (1.5±0.7 vs 0.68±0.2 liters/min, 0.4±0.2 vs 0.24 ±0.06 liters/min, respectively). There was an increase in the preload at the final study, as evidenced by a marked increase in right atrial (3.1±1.6 vs 4.35±2.2 mm Hg, +15%,P<0.05), pulmonary arterial (12.2±2.4 vs 15.9±3.2 mm hg, +31.8%,P<0.001), and wedge pulmonary arterial pressures (6.9±2.4 vs 9.8±3.1 mm Hg, +53%,P<0.001). These results suggest that TIPS worsens the hyperdynamic syndrome associated to portal hypertension. Therefore, in patients with cardiac insufficiency, this procedure should be evaluated. TIPS also decreases the hepatic blood flow, inducing a mild worsening in liver function.
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Hadengue A, Moreau R, Sogni P, Soupison T, Vilgrain V, Lebrec D: Risque d'effets hémodynamiques indésirables après shunt portosystémique intra-hépatique: Expérience préliminaire. Paper presented at the Association Française pour l'Etude du Foie, Paris, 1992
Helton WS, Belshaw A, Althaus S, Park S, Coldwell D, Johansen K: Critical appraisal of the angiographic portacaval shunt (TIPS). Am J Surg 5:566–571, 1993
Lotterer E, Wengert A, Moosmüller A, Hahn EG, Fleig WE: Effects of transjugular intrahepatic portalsystemic shunt (TIPS) on hepatic and systemic hemodynamics in patients with alcoholic cirrhosis. Hepatology 18(suppl):102A, 1993
Hounker M, Schumacher O, Ochs A, Haag K, Hauenstein AH, Keul J: Acute hemodynamic effects of TIPS. Hepatology 18(suppl):281A, 1993
Azoulay D, Castaing D, Dennison A, Martino W, Eyraud D, Bismuth H: Transjugular intrahepatic portosystemic shunt worsens the hyperdynamic circulatory state of the cirrhotic patient: Preliminary report of a prospective study. Hepatology 19(1):129–132, 1994
Echenagusia AJ, Camuñez F, Simó G, Peiró J, Garay MG, Rodríguez-Laiz JM, Bañares R: Variceal hemorrhage: Efficacy of transjugular intrahepatic portosystemic shunts created with Strecker stents. Radiology 192:235–240, 1994
Cwikiel W, Stridbeck H: Experimental transjugular portacaval shunt: Use of a fine-needle puncture device for the implantation of Strecker stents. Acta Radiol 33:356–359, 1992
Groszmann RJ, Glickman M, Blei A, Storer E, Conn HO: Wedge and free hepatic venous pressure measured with a balloon catheter. Gastroenterology 76:256–258, 1979
Caesar J, Shaldon S, Chiandussi L, Guevara L, Sherlock S: The use of indocyanine green in the measurement of hepatic blood flow and as a test of hepatic function. Clin Sci 21:43–57, 1961
Villeneuve JP, Huot R, Marleau D, Huet PM: The stimulation of hepatic blood flow with indocyanine green: comparison between the continuous infusion and single injection methods. Am J Gastroenterol 77:233–237, 1982
Conn HO: Trailmaking and number-connection tests in the assessment of mental state in portal-systemic encephalopathy. Dig Dis 22:541–550, 1977
Groszmann RJ: Hyperdynamic state in chronic liver diseases. J Hepatol 17(suppl 2):38–40, 1993
Hadengue A, Benhayoun MK, Lebrec D, Benhamou JP: Pulmonary hypertension complicating portal hypertension: prevalence and relation to splanchnic hemodynamics. Gastroenterology 100(2):520–528, 1991
Spina G, Santambrogio R: The role of portosystemic shunting in the management of portal hypertension. Baillieres Clin Gastroenterol 6:497–515, 1992
Lacy AM, Navasa M, Gilabert R, Brú C, García-Pagán JC, García-Valdecasas JC, Bosch J, Rodes J: Long-term effects of distal splenorenal shunt on hepatic hemodynamics and liver function in patients with cirrhosis: importance of reversal of portal blood flow. Hepatology 15:616–622, 1992
Luca A, Cirera I, Pereira O, Feu F, García-Pagán JC, Fernandez M, Bosch J, Rodes J: Normalization of portal pressure following end-to-side portocaval shunt worsens systemic hemodynamic abnormalities in cirrhosis. Hepatology 13(suppl 2):S46, 1991
Beattie C, Stizmann JV, Cameron JL: Mesoatrial shunt haemodynamycs. Surgery 104:1–9, 1988
Del Guercio LRM, Commaraswamy RP, Feins NR: Pulmonary arteriovenous admixture and the hyperdynamics cardiovascular state in surgery for portal hypertension. Surgery 56:57–74, 1964
Sorensen BM, Bille-Brahe NE, Christiansen L: Hemodynamics in patients undergoing portocaval shunt operations. Acta Anesth Scand 26:425–428, 1982
Senior RM, Britton RC, Turino GM: Pulmonary hypertension associated with cirrhosis of the liver and with portocaval shunt. Circulation 37:88–96, 1968
Robalino BD, Moodie DS: Association between primary pulmonary hypertension and portal hypertension: Analysis of its pathophysiology and clinical, laboratory and hemodynamic manifestations. J Am Coll Cardiol 17:492–498, 1961
Hadengue A, Lebrec D, Benhamou JP: Pulmonary arterial hypertension in patients with portal hypertension.In Portal Hypertension: Clinical and Pathophysiological Aspects. K Okuda, JP Benhamou (eds). Tokyo, Springer-Verlag, 1991, pp 401–411
Pomier-Layrargues G, Huet PM, Infante-Rivard C, Villeneuve JP, Marleau D, Duguay L: Prognostic value of indocyanine green and lidocaine kinetics for survival and chronic encephalopathy in cirrhotics patients following elective end-to-side portocaval shunt. Hepatology 6:1506–1510, 1988
Barbare JC, Poupon RE, Jaillon P, Prodhomme S, Darnis F, Poupon RY: Intrinsic hepatic clearance and Child-Turcotte classification for assessment of liver function in cirrhosis. J Hepatol 1:253–259, 1985
Bosch J, Groszmann RJ: Measurement of the azygos venous blood flow by a continuous thermodilution technique: An index of blood flow through gastroesophageal collaterals in cirrhosis. Hepatology 4:424–429, 1984
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Funded in part by the Fondo de Investigaciones Sanitarias de la Seguridad Social, grant 94/0240.
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Rodríguez-Laiz, J.M., Bańares, R., Echenagusia, A. et al. Effects of transjugular intrahepatic portasystemic shunt (TIPS) on splanchnic and systemic hemodynamics, and hepatic function in patients with portal hypertension. Digest Dis Sci 40, 2121–2127 (1995). https://doi.org/10.1007/BF02208995
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DOI: https://doi.org/10.1007/BF02208995