Original Article
The Transjugular Intrahepatic Portosystemic Stent–Shunt Procedure for Refractory Ascites
N Engl J Med 1995; 332:1192-1197May 4, 1995
- Abstract
Background
Previous studies have suggested that the transjugular placement of an intrahepatic stent to establish a portosystemic shunt is an effective treatment of uncomplicated ascites accompanying variceal bleeding. We studied the stent shunt for use in patients with liver cirrhosis and ascites refractory to medical treatment.
Methods
Fifty of 62 consecutive patients with cirrhosis and refractory ascites were treated with the stent shunt — an expandable stent of metallic mesh placed between a major branch of the portal vein and one of the hepatic veins. Patients were followed for a mean (±SD) of 426±333 days.
Results
The stent shunt was successfully placed in all patients and reduced the pressure gradient between the portal vein and the inferior vena cava by an average of 63 percent. Thirty-seven patients (74 percent) had complete responses (total remission of ascites within three months), and nine patients (18 percent) had partial responses. Four patients did not respond, including two who died within two weeks of shunt placement. After the procedure, 25 patients had hepatic encephalopathy, as compared with 20 patients before the procedure; although encephalopathy improved in 3 patients, new encephalopathy developed in 8 patients. In the 28 of the 33 patients followed for more than six months who were evaluated, the mean serum creatinine concentration was 1.5±0.09 mg per deciliter (133±8 μmol per liter) before placement of the stent shunt, 1.5±1.6 mg per deciliter (133±141 μmol per liter) one week after the procedure, and 0.9±0.3 mg per deciliter (80±27 μmol per liter) after six months (P = 0.008 for the comparison of concentrations before and six months after the procedure). Renal function did not improve in the six patients with organic kidney disease. Procedure-related complications developed in 16 patients. During follow-up, an additional 29 patients died — 10 of progressive liver disease and 19 of other causes. Survival for at least one year was associated with a patient's being under 60 years of age, having a serum bilirubin level before placement of the stent shunt of less than 1.3 mg per deciliter (22 μmol per liter), and having a complete response.
Conclusions
Our findings in an uncontrolled prospective study suggest that the transjugular intrahepatic portosystemic stent–shunt procedure was an effective treatment for many patients with liver cirrhosis and refractory ascites, but mortality from underlying diseases was substantial.
Media in This Article
Figure 2
Kaplan–Meier Survival Analysis of All Patients and of Patients According to Their Responses to Treatment.Figure 1
Severity of Ascites before and after the Stent–Shunt Procedure.Article Activity
- Article
Refractory ascites is the complication of portal hypertension that most severely affects both quality of life and long-term survival.1-5 Depending on the patient's general clinical state and whether there are additional complications, such as renal insufficiency and variceal bleeding, the rate of survival at one year is 20 to 50 percent.6-9 Survival has not been improved significantly by either paracentesis7,10,11 or peritoneovenous shunting.12-18
Portal hypertension is a major contributor to ascites formation, and decompression of the portal vein by surgical shunts is a plausible treatment.19-22 However, the procedure has not been shown to improve survival, probably because of the operative mortality of 5 to 39 percent,19-23 and has therefore been more or less abandoned.
The transjugular intrahepatic portosystemic stent shunt is a nonsurgical side-to-side shunt consisting of a stented channel between a main branch of the portal vein and a hepatic vein.24-26 The stent shunt has been shown to be an effective treatment of uncomplicated ascites accompanying variceal bleeding,24 with an operative mortality of about 1 percent. We studied the use of this procedure for refractory ascites.
Methods
We studied 50 of 62 consecutive patients with refractory ascites who were treated between January 1989 and September 1993 and followed for a mean (±SD) of 426±333 days. The characteristics of the patients are given in Table 1Table 1
Characteristics of the 50 Patients Studied.. All the patients had one or more additional liver-related complications (e.g., recent variceal bleeding) or severe accompanying disease. Renal function was impaired in about half the patients. In four patients who were undergoing hemodialysis, the reason for the stent–shunt treatment was to ameliorate arterial hypotension complicating hemodialysis and thus causing a fluid loss. The 12 patients who were excluded had advanced hepatic cancer (4 patients) or advanced extrahepatic cancer (2 patients), severe heart failure (2 patients), or severe liver failure (4 patients).Refractory ascites was defined as tense ascites without a decrease in body weight during at least four weeks of a standard treatment consisting of saline restriction (<60 mmol of sodium per day), spironolactone (300 to 400 mg per day), and furosemide (120 mg per day),6 or with intolerance of the standard treatment (a serum sodium concentration of <125 mmol per liter, a serum creatinine concentration of >2.4 mg per deciliter [212 μmol per liter], or allergy to spironolactone and furosemide). In patients with serum sodium concentrations of less than 125 mmol per liter, fluid intake was restricted to 1 liter per day. Mild and severe functional renal failure were defined by the repeated finding of serum creatinine concentrations of more than 1.2 and less than 2.4 mg per deciliter (106 and 212 μmol per liter) and of 2.4 mg per deciliter or more, respectively, accompanied by urinary sodium concentrations of less than 10 mmol per liter in the presence of a central venous pressure of more than 8 cm of water. Organic kidney disease was excluded. Kidney function was tested during diuretic treatment in all patients except the 14 whose diuretic agents were withdrawn because of severe renal impairment (11 patients) or low serum sodium concentrations (3 patients). Renal function was not measured during the three days following large-volume paracentesis.
A complete response was defined as a total remission of ascites within three months. A partial response was defined as the presence of sonographically detectable ascites without the need for paracentesis. An absent response was defined as the persistence of severe ascites requiring paracentesis.
All patients in the study were hospitalized for at least four weeks before treatment to establish the diagnosis of refractory ascites or functional renal failure. Before the stent–shunt procedure, the following procedures were performed: urinalysis, including measurement of creatinine clearance and daily sodium and protein excretion, as well as ascitic-fluid analysis; an assessment of hepatic encephalopathy (including a number-connection test and a mental-status test); and duplex and abdominal sonography. Before treatment, ascitic fluid was removed by paracentesis, with albumin substituted intravenously (8 g of albumin per liter of fluid removed). Lactulose, antibiotics, dopamine, and other cardiac or pulmonary medications were given as warranted. After the implantation of the stent shunt, diuretic treatment was gradually reduced, the rate of reduction depending on the urinary output or the reduction in body weight. Patients were sent home from the hospital when their hepatic and renal functioning was stable or improving. Subsequently, they were seen after four weeks and then at three-month intervals. No patient was lost to follow-up.
The technique of placing a transjugular intrahepatic stent to establish a portosystemic shunt and the postprocedural management (e.g., anticoagulation) have been described previously.24,26 After mild intravenous sedation and analgesia (50 to 100 mg of meperidine and 1 to 5 mg of midazolam), a puncture needle was advanced transjugularly in a catheter through the inferior vena cava into one of the three hepatic veins. Subsequently, an intrahepatic branch of the portal vein was punctured and the shunt was established by the implantation of either the Palmaz stent (Johnson and Johnson Interventional Systems, Warren, N.J.), which was used in 36 patients (2.4±1.0 stents per patient) or the Wallstent (Schneider, Bülach, Switzerland), used in 14 patients (1.2±0.4 stents per patient). (A lengthy shunt path may require multiple stents.) The study was approved by the local ethics committee, and written informed consent was obtained from all patients.
Statistical Analysis
Differences in the survival curves were determined by Kaplan–Meier analysis and the log-rank test (Cox–Mantel). Comparative results of repeated and serial measurements were analyzed by the paired t-test and the Wilcoxon–Wilcox test, respectively. The significance of changes in the severity of ascites was analyzed with the statistical sign test (Dixon–Mood). All the tests were two-sided, with a significance level of P = 0.05. The statistical analyses were performed with Winstat 3.0 software (Kalmia, Cambridge, Mass.).
Results
The stent shunt was successfully established in all 50 patients. The portal venous pressure gradient was reduced by an average of 63 percent, partly as a result of an increase in the inferior vena caval pressure (Table 2Table 2
Portal and Vena Caval Pressure before and after the Stent–Shunt Procedure as Determined during the Procedure in the 50 Patients.). A total of 20 complications occurred in 16 patients and included intraabdominal bleeding requiring blood transfusions (2 patients), stent dislocation and subsequent placement of the stent in the right iliac vein (1 patient), septicemia (Staphylococcus aureus, 1 patient) or a temperature above 38.5°C (4 patients), cardiac arrhythmia requiring treatment during the procedure (sinus tachycardia, 2 patients; sinus bradycardia, 1 patient), and malaise and vomiting after the procedure (3 patients). Six patients had transient deterioration of their renal function induced by the contrast medium (iopromide). Two of these patients required hemodialysis for one to two weeks.Ascites and Shunt Function
Overall, 46 patients (92 percent) responded to the treatment. Thirty-seven (74 percent) had complete responses, and nine (18 percent) had partial responses. In those with partial responses, the responses were limited by recurrent spontaneous bacterial peritonitis (six patients) and severe organic kidney disease (three patients). There was no response in four patients — one with recurrence of tumor-induced portal-vein thrombosis, one with treatment-resistant peritonitis, and two who died within two weeks of the procedure, while still in the hospital (one of myocardial infarction, the other of diffuse gastrointestinal hemorrhage and disseminated intravascular coagulation after hemodialysis). All the patients who responded (excluding those who were undergoing hemodialysis) required low doses of diuretics (e.g., 100 mg of spironolactone or 40 mg of furosemide per day, or both) to maintain their responses and to treat peripheral edema. Two of the four patients who were undergoing hemodialysis before the stent–shunt procedure had complete responses, one had a partial response, and the fourth died of septicemia two weeks after the procedure.
The severity of ascites during the first three months of follow-up is shown in Figure 1Figure 1
Severity of Ascites before and after the Stent–Shunt Procedure.. Significant improvement was seen within one week (P<0.001). At three months, 8 of the 36 patients who were alive had moderate or mild ascites. The patients with complete responses had a mean (±SD) decrease in body weight of 10.7±6.1 kg (P<0.001). The 31 patients with complete responses who were followed for more than six months had an initial decrease in mean body weight from 74.5±13.6 kg to 64.8±11.7 kg (P<0.001), and then an increase to 69±15 kg (P<0.001). We attributed the increased weight to a visible improvement in the nutritional status of the patients.The response to treatment could not be predicted on the basis of the serum creatinine concentration before the stent–shunt procedure, the serum or ascites albumin concentration, or the portal and caval pressures or the portal venous pressure gradient before or after the procedure. Thrombotic occlusion of the stent shunt occurred within two weeks in 5 patients, and later shunt insufficiency occurred in 16. Later shunt insufficiency was indicated by the recurrence of ascites after complete remission (in 12 patients) and variceal bleeding (in 1), respectively. In three patients, shunt stenosis was diagnosed by duplex sonography without the reappearance of ascites and did not require reestablishment of the shunt. In the other patients, the shunt was reestablished, in all but one patient with tumor thrombosis, by local thrombolysis, balloon dilatation, and placement of additional stents.
Renal Function after the Stent–Shunt Procedure
Table 3Table 3
Serum Creatinine Concentration, Creatinine Clearance, and Urinary Sodium Excretion before and after the Stent–Shunt Procedure in Patients without Organic Kidney Disease. shows the results of kidney-function tests before and after the stent–shunt procedure in patients without organic kidney disease. In the 33 patients followed for more than six months, the serum creatinine concentration and creatinine clearance did not change during the first week after the procedure, whereas urinary sodium excretion improved significantly. After six months, however, both the serum creatinine concentration and the creatinine clearance improved significantly. Early effects were similar in the 10 patients who died during the first six months. In the six patients with organic kidney disease (data not shown), the stent shunt did not improve renal function, and hemodialysis had to be continued in four patients. Dialysis was facilitated by decreased arterial hypotension, allowing more fluid to be removed.Liver Function and Hepatic Encephalopathy
In the 31 patients followed for more than six months for whom data were complete, the mean serum bilirubin concentration worsened significantly (P = 0.006) during the first month, from 2.5±0.3 to 3.2±0.3 mg per deciliter (43±5.1 to 55±5.1 μmol per liter), but improved during the subsequent five months to 2.1±0.3 mg per deciliter (36±5.1 μmol per liter). The mean serum albumin increased by 20 percent (from 3.0±0.6 to 3.6±0.7 g per deciliter, P<0.001) within the six-month observation period. This increase may be attributed to decreased ascites and to the fact that paracentesis was not performed, and may only in part reflect improved hepatic function.
The number of patients with hepatic encephalopathy increased from 20 patients before the stent–shunt procedure to 25 after it; the condition of 3 patients improved after the procedure, but new hepatic encephalopathy developed in 8. Hepatic encephalopathy was debilitating in 8 of the 25 patients and resistant to medical treatment. Progressive liver failure developed in all these patients, and all died. Two other patients with chronic hepatic encephalopathy received liver transplants, 1 and 11 months, respectively, after the stent–shunt procedure.
Mortality
In addition to the 2 patients who died in the hospital, 29 died during follow-up, 10 of them from progressive liver failure 34 to 260 days after the stent–shunt implantation. An increase in the bilirubin concentration of more than 100 percent within one month and continued heavy drinking of alcohol were significantly correlated with progressive liver failure. Other causes of death were infection (five patients), heart disease (five), hepatocellular carcinoma (three), nonvariceal upper gastrointestinal bleeding (three), and unknown causes (three).
Survival for at least one year after establishment of the stent shunt was associated with a patient's being under 60 years of age, having a serum bilirubin concentration before the stent–shunt procedure of less than 1.3 mg per deciliter (22 μmol per liter), and having a complete response to treatment (Table 4Table 4
Kaplan–Meier Estimates of Survival According to Age, Child–Pugh Class, Response to Treatment, and Bilirubin and Creatinine Concentrations before the Stent–Shunt Procedure.). Overall survival was not related to renal function before the stent–shunt procedure, although patients with severe functional renal failure (creatinine concentration >2.4 mg per deciliter) did better than patients with organic kidney disease. There was no correlation between survival and the Child–Pugh class, the cause of liver disease (alcoholic versus nonalcoholic), or the presence of hepatic encephalopathy before or after the stent–shunt procedure. Figure 2Figure 2Kaplan–Meier Survival Analysis of All Patients and of Patients According to Their Responses to Treatment. shows the Kaplan–Meier survival estimates for all patients and for patients according to their responses to treatment. Median survival for all patients was estimated to be 382 days. For those who had complete responses, median survival was estimated to be 558 days, as compared with 75 days for those with partial or no responses.Discussion
In an uncontrolled prospective study, we found that the transjugular intrahepatic portosystemic stent shunt was an effective treatment for refractory ascites and that 74 percent of the patients had complete responses. These results may be due to both decompression of the portal system and improved renal function. Improved renal function may be related to increased vascular filling, as indicated by a marked increase in the central venous pressure and a decrease in hyperaldosteronism, which has been reported with surgical20,22 and transjugular28 shunts. Most of the patients gained weight. This well-known effect of portosystemic shunts20,22,29 may be due to improved absorption of nutrients and shunt-induced hyperinsulinism.
In some patients, functional renal failure and organic kidney disease may have contributed to the formation of ascites. Improvement in both ascites and renal function was seen in all 16 patients with functional renal failure, regardless of severity, but not in the 6 patients with organic kidney disease. Improvement in functional renal failure with the stent shunt has also been suggested by others.30 In a preliminary study,31 the stent shunt decreased plasma endothelin-1, which is thought to have a key role in the pathogenesis of functional renal failure.32 Other treatments of refractory ascites, such as peritoneovenous shunting and paracentesis, are ineffective or may aggravate functional renal failure.33
As expected, the stent shunt led to a considerable increase in the incidence of hepatic encephalopathy, which was debilitating in eight patients who died of liver failure. We believe that shunt reduction (achieved by inserting a reduced-diameter stent into the original stent tract)34 or liver transplantation must be considered in those patients unless shunt stenosis or occlusion occurs spontaneously. In patients with spontaneous shunt insufficiency and previous shunt-induced encephalopathy, the reestablishment of the stent shunt is not indicated. In patients with insufficient shunting and no reappearance of ascites, we believe that attempts to improve the shunt are also not indicated. In these patients, transient decompression may have been sufficient for long-term control of ascites.
Some patients had transient deterioration of renal function induced by the contrast medium. Otherwise, no severe technical complication developed. There were no deaths from procedure-related complications. The small number of deaths (two) while patients were in the hospital may be explained in part by rapid improvement in renal function and ascites, which may have reduced the risk of further episodes of spontaneous bacterial peritonitis.35 Variceal bleeding or repeated bleeding is another common cause of death in such patients. Only 1 of 16 patients with recent variceal bleeding had repeated episodes of bleeding.
Surgical shunts and the transjugular intrahepatic portosystemic stent shunt share the therapeutic principle of decompression of the portal system and therefore may have a comparable efficacy. Surgical shunts, however, complicate liver transplantation. The early mortality rate after the placement of surgical shunts is reported to range from 5 to 39 percent.19-23 Controlled, randomized trials will be necessary to compare survival after the transjugular stent–shunt procedure with that after other procedures.
In contrast to our findings, the transjugular intrahepatic portosystemic stent shunt in an earlier study led to complete resolution of ascites in only 7 of 14 patients with refractory ascites.36 Treatment failed predominantly in patients in Child–Pugh class C — that is, in those with very high Child–Pugh scores (more than 11). This association with Child–Pugh class was not confirmed by our results.
In our study, being under 60 years of age, having a low pretreatment serum bilirubin concentration (<1.3 mg per deciliter), and having a complete response to treatment were all associated with survival for at least one year. Patients with organic kidney disease had a poor prognosis. We believe that such patients should not receive this treatment. Liver transplantation should be considered for patients with early increases in the bilirubin concentration of more than 100 percent or patients with incomplete responses to the stent shunt.
Source Information
From the Departments of Medicine (A.O., M.R., K.H., P.D., V.S., M.H., H.E.B.) and Radiology (K.-H.H., M.L.), Albert Ludwig University School of Medicine, Freiburg, Germany.
Address reprint requests to Dr. Rössle at the Medizinische Universitätsklinik II, Hugstetterstr. 55, 79106 Freiburg, Germany.
- References
References
1
Runyon BA . Care of patients with ascites. N Engl J Med 1994;330:337-342
Full Text | Web of Science | Medline2
Epstein M . Treatment of refractory ascites. N Engl J Med 1989;321:1675-1677
Full Text | Web of Science | Medline3
Arroyo V ,Epstein M ,Gallus G ,Gentilini P ,Ring-Larsen H ,Salerno F . Refractory ascites in cirrhosis: mechanism and treatment. Gastroenterol Int 1989;2:195-2074
Saunders JB ,Walters JR ,Davies AP ,Paton A . A 20-year prospective study of cirrhosis. BMJ 1981;282:263-266
CrossRef | Web of Science | Medline5
Capone RR ,Buhac I ,Kohberger RC ,Balint JA . Resistant ascites in alcoholic liver cirrhosis: course and prognosis. Am J Dig Dis 1978;23:867-871
CrossRef | Medline6
Gines P ,Tito L ,Arroyo V , et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology 1988;94:1493-1502
Web of Science | Medline7
Gines P ,Arroyo V ,Vargas V , et al. Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites. N Engl J Med 1991;325:829-835
Full Text | Web of Science | Medline8
Salerno F ,Borroni G ,Moser P , et al. Survival and prognostic factors of cirrhotic patients with ascites: a study of 134 outpatients. Am J Gastroenterol 1993;88:514-519
Web of Science | Medline9
Ferro D ,Saliola M ,Quintarelli C , et al. 1-Year survey of patients with advanced liver cirrhosis: prognostic value of clinical and laboratory indexes identified by the Cox regression model. Scand J Gastroenterol 1992;27:852-856
CrossRef | Web of Science | Medline10
Kellerman PS ,Linas SL . Large-volume paracentesis in treatment of ascites. Ann Intern Med 1990;112:889-891
Web of Science | Medline11
Smart HL ,Triger DR . A randomised prospective trial comparing daily paracentesis and intravenous albumin with recirculation in diuretic refractory ascites. J Hepatol 1990;10:191-197
CrossRef | Web of Science | Medline12
Leveen HH ,Christoudias G ,Ip M ,Luft R ,Falk G ,Grosberg S . Peritoneo-venous shunting for ascites. Ann Surg 1974;180:580-591
CrossRef | Web of Science | Medline13
Fulenwider JT ,Galambos JD ,Smith RB III ,Henderson JM ,Warren WD . LeVeen vs Denver peritoneovenous shunts for intractable ascites of cirrhosis: a randomized, prospective trial. Arch Surg 1986;121:351-355
Web of Science | Medline14
Stanley MM ,Ochi S ,Lee KK , et al. Peritoneovenous shunting as compared with medical treatment in patients with alcoholic cirrhosis and massive ascites. N Engl J Med 1989;321:1632-1638
Full Text | Web of Science | Medline15
Moskovitz M . The peritoneovenous shunt: expectations and reality. Am J Gastroenterol 1990;85:917-929
Web of Science | Medline16
Scholz DG ,Nagorney DM ,Lindor KD . Poor outcome from peritoneovenous shunts for refractory ascites. Am J Gastroenterol 1989;84:540-543
Web of Science | Medline17
Bories P ,Garcia Compean D ,Michel H , et al. The treatment of refractory ascites by the LeVeen shunt: a multi-centre controlled trial (57 patients). J Hepatol 1986;3:212-218
CrossRef | Web of Science | Medline18
Bernhoft RA ,Pellegrini CA ,Way LW . Peritoneovenous shunt for refractory ascites: operative complications and long-term results. Arch Surg 1982;117:631-635
Web of Science | Medline19
Elcheroth J ,Vons C ,Franco D . Role of surgical therapy in management of intractable ascites. World J Surg 1994;18:240-245
CrossRef | Web of Science | Medline20
Tamaki A ,Golby M ,Orloff MJ . Effects of side-to-side portacaval shunt on hepatic hemodynamics and metabolism. Surg Forum 1968;19:324-326
Medline21
Burchell AR ,Rousselot LM ,Panke WF . A seven-year experience with side-to-side portacaval shunt for cirrhotic ascites. Ann Surg 1968;168:655-670
CrossRef | Web of Science | Medline22
Orloff MJ . Pathogenesis and surgical treatment of intractable ascites associated with alcoholic cirrhosis. Ann N Y Acad Sci 1970;170:213-238
CrossRef | Web of Science23
Franco D ,Vons C ,Traynor O ,de Smadja C . Should portosystemic shunt be reconsidered in the treatment of intractable ascites in cirrhosis? Arch Surg 1988;123:987-991
Web of Science | Medline24
Rossle M ,Haag K ,Ochs A , et al. The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding. N Engl J Med 1994;330:165-171
Full Text | Web of Science | Medline25
LaBerge JM ,Ring EJ ,Gordon RL , et al. Creation of transjugular intrahepatic portosystemic shunts with Wallstent endoprosthesis: results in 100 patients. Radiology 1993;187:413-420
Web of Science | Medline26
Ochs A ,Sellinger M ,Haag K , et al. Transjugular intrahepatic portosystemic stent-shunt (TIPS) in the treatment of Budd-Chiari syndrome. J Hepatol 1993;18:217-225
CrossRef | Web of Science | Medline27
Pugh RNH ,Murray-Lion IM ,Dawson JL ,Pietroni MC ,Williams R . Transection of the oesophagus for bleeding oesphageal varices. Br J Surg 1973;60:646-649
CrossRef | Web of Science | Medline28
Villarreal LG ,Urmeneta JMZ ,Vila JQ , et al. Prótesis intrahepatica portosistémica: PIP (TIPS) en el tratamiento de la ascitis refractaria. Estudio piloto. Gastroenterol Hepatol 1993;16:18-2229
Campbell DP ,Parker DE ,Anagnostopoulos CE . Survival prediction in portacaval shunts: a computerized statistical analysis. Am J Surg 1973;126:748-751
CrossRef | Web of Science | Medline30
Lake JR ,Ring E ,LaBerge J ,Gordon R ,Roberts J ,Ascher N . Transjugular intrahepatic portacaval stent shunts in patients with renal insufficiency. Transplant Proc 1993;25:1766-1767
Web of Science | Medline31
Martinet JP ,Legault L ,Cernacek P , et al. Effect of TIPS on splanchnic and renal production of endothelins. Hepatology 1994;20:113A-113A abstract.
Web of Science32
Epstein M . Hepatorenal syndrome: emerging perspectives of pathophysiology and therapy. J Am Soc Nephrol 1994;4:1735-1753
Web of Science | Medline33
Arroyo V ,Gines P ,Planas R ,Panes J ,Rodes J . Management of patients with cirrhosis and ascites. Semin Liver Dis 1986;6:353-369
CrossRef | Web of Science | Medline34
Hauenstein KH ,Haag K ,Ochs A ,Langer M ,Rossle M . The reducing stent: treatment for transjugular intrahepatic portosystemic shunt-induced refractory hepatic encephalopathy and liver failure. Interventional Radiol 1995;194:175-17935
Llovet JM ,Planas R ,Morillas R , et al. Short-term prognosis of cirrhotics with spontaneous bacterial peritonitis: multivariate study. Am J Gastroenterol 1993;88:388-392
Web of Science | Medline36
Ferral H ,Bjarnason H ,Wegryn SA , et al. Refractory ascites: early experience in treatment with transjugular intrahepatic portosystemic shunt. Radiology 1993;189:795-801
Web of Science | Medline
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María E. Baccaro, Mónica Guevara. (2007) Síndrome hepatorrenal. Gastroenterología y Hepatología 30:9, 548-554
CrossRef21
Gil Weitzman, Neil J. Schamberg, Gerond Lake-Bakaar. (2007) Synergism Between Hepatocellular Injury and Shunting in Portosystemic Encephalopathy (PSE): Case Report of Acute Brittle TIPS-Induced PSE. Digestive Diseases and Sciences 52:11, 3270-3274
CrossRef22
Lourdes S. Pahuriray, Patricia T. Alpert, Susan Kowalski. (2007) Budd?Chiari syndrome from an advanced practice nurse perspective. Journal of the American Academy of Nurse Practitioners 19:9, 486-495
CrossRef23
Francesco Salerno, Calogero Cammà, Marco Enea, Martin Rössle, Florence Wong. (2007) Transjugular Intrahepatic Portosystemic Shunt for Refractory Ascites: A Meta-analysis of Individual Patient Data. Gastroenterology 133:3, 825-834
CrossRef24
Vanessa Stadlbauer, Josef Tauss, Horst R. Portugaller, Philipp Stiegler, Florian Iberer, Rudolf E. Stauber. (2007) Hepatic encephalopathy following transjugular intrahepatic portosystemic shunt (TIPS): Management with l-ornithine-l-aspartate and stent reduction. Metabolic Brain Disease 22:1, 45-50
CrossRef25
Jean-Baptiste Bachet, Bertrand Condat, Hervé Hagège, Aurélie Plessier, Yann Consigny, Jacques Belghiti, Dominique Valla. (2007) Long-term portosystemic shunt patency as a determinant of outcome in Budd–Chiari syndrome. Journal of Hepatology 46:1, 60-68
CrossRef26
Dale A. Dangleben, Omid Jazaeri, Thomas Wasser, Mark Cipolle, Michael Pasquale. (2006) Impact of Cirrhosis on Outcomes in Trauma. Journal of the American College of Surgeons 203:6, 908-913
CrossRef27
Marco Senzolo, Evangelos Cholongitas, Jonathan Tibballs, Andrew Burroughs, David Patch. (2006) Transjugular intrahepatic portosystemic shunt in the management of ascites and hepatorenal syndrome. European Journal of Gastroenterology & Hepatology1143-1150
CrossRef28
Paul Harrod-Kim, Wael Saad, David Waldman. (2006) Predictors of Early Mortality after Transjugular Intrahepatic Portosystemic Shunt Creation for the Treatment of Refractory Ascites. Journal of Vascular and Interventional Radiology 17:10, 1605-1610
CrossRef29
FERNANDO MEMBRENO, ARTURO L BAEZ, REKA PANDULA, ERIC WALSER, DARYL T-Y LAU. (2006) Differences in long-term survival after transjugular intrahepatic portosystemic shunt for refractory ascites and variceal bleed. Journal of Gastroenterology and Hepatology 0:0, 060606032707118
CrossRef30
Ahmed Helmy, Doris N. Redhead, Adrian J. Stanley, Peter C. Hayes. (2006) The natural history of parallel transjugular intrahepatic portosystemic stent shunts using uncovered stent: the role of host-related factors. Liver International 26:5, 572-578
CrossRef31
Stefanie M. Rosenberg. (2006) Palliation of Malignant Ascites. Gastroenterology Clinics of North America 35:1, 189-199
CrossRef32
I. Kürer, A. Sommerer, G. Puhl, U. Kaisers, W. Boemke. (2006) Hepatorenales Syndrom. Der Anaesthesist 55:1, 95-109
CrossRef33
Gennaro D’Amico, Angelo Luca, Alberto Morabito, Roberto Miraglia, Mario D’amico. (2005) Uncovered Transjugular Intrahepatic Portosystemic Shunt for Refractory Ascites: A Meta-Analysis. Gastroenterology 129:4, 1282-1293
CrossRef34
Wael E.A. Saad, Mark G. Davies, David E. Lee, Nikhil C. Patel, Lawrence G. Sahler, Talia Sasson, Takashi Kitanososno, David L. Waldman. (2005) Transjugular Intrahepatic Portosystemic Shunt in a Living Donor Left Lateral Segment Liver Transplant Recipient: Technical Considerations. Journal of Vascular and Interventional Radiology 16:6, 873-877
CrossRef35
P. Deltenre, P. Mathurin, S. Dharancy, R. Moreau, P. Bulois, J. Henrion, F. R. Pruvot, O. Ernst, J. C. Paris, D. Lebrec. (2005) Transjugular intrahepatic portosystemic shunt in refractory ascites: a meta-analysis. Liver International 25:2, 349-356
CrossRef36
FERNANDO MEMBRENO, ARTURO L BAEZ, REKA PANDULA, ERIC WALSER, DARYL T-Y LAU. (2005) Differences in long-term survival after transjugular intrahepatic portosystemic shunt for refractory ascites and variceal bleed. Journal of Gastroenterology and Hepatology 20:3, 474-481
CrossRef37
Pratima Sharma, Jorge Rakela. (2005) Management of pre-liver transplantation patient?Part 2. Liver Transplantation 11:3, 249-260
CrossRef38
Erik Bahn, Jens Wiltfang, Wilhelm Nolte, Guiliano Ramadori, Bernhard Steinhoff, Eckhardt Rüther, Christoph Kurth. (2005) Quantification of Changes in Electroencephalographic Power Spectra in a Patient with Budd-Chiari-Syndrome after Implantation of a Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS). Metabolic Brain Disease 20:1, 1-6
CrossRef39
Andres Cardenas. (2005) Hepatorenal Syndrome: A Dreaded Complication of End-Stage Liver Disease. The American Journal of Gastroenterology 100:2, 460-467
CrossRef40
Andreas Ochs. (2005) Transjugular Intrahepatic Portosystemic Shunt. Digestive Diseases 23:1, 56-64
CrossRef41
Pratima Sharma, Hugo E. Vargas, Jorge Rakela. 2005. Monitoring and Care of the Patient Before Liver Transplantation. , 473-489.
CrossRef42
Andrés Cárdenas, Vicente Arroyo. (2005) Refractory Ascites. Digestive Diseases 23:1, 30-38
CrossRef43
FRANCIS DUDLEY. (2004) Management of refractory ascites. Journal of Gastroenterology and Hepatology 19:s7, S194-S199
CrossRef44
Satheesh Nair, Ranvir Singh, Moises Yoselewitz. (2004) Correlation Between Portal/Hepatic Vein Gradient and Response to Transjugular Intrahepatic Portosystemic Shunt Creation in Refractory Ascites. Journal of Vascular and Interventional Radiology 15:12, 1431-1434
CrossRef45
Francesco Salerno, Manuela Merli, Oliviero Riggio, Massimo Cazzaniga, Valentina Valeriano, Massimo Pozzi, Antonio Nicolini, Filippo Salvatori, . (2004) Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites. Hepatology 40:3, 629-635
CrossRef46
Alexander S. Rosemurgy, Emmanuel E. Zervos, Whalen C. Clark, Donald P. Thometz, Thomas J. Black, Bruce R. Zwiebel, Bruce T. Kudryk, L Shane Grundy, Larry C. Carey. (2004) TIPS Versus Peritoneovenous Shunt in the Treatment of Medically Intractable Ascites. Annals of Surgery 239:6, 883-891
CrossRef47
Ginès, Pere, Cárdenas, Andrés, Arroyo, Vicente, Rodés, Juan, . (2004) Management of Cirrhosis and Ascites. New England Journal of Medicine 350:16, 1646-1654
Full Text48
M. González García, L. Ruiz del Árbol Olmos, A. Albillos Martínez. (2004) Ascitis y síndrome hepatorrenal. Medicine - Programa de Formación Médica Continuada Acreditado 9:8, 504-512
CrossRef49
Stefania Angeloni, Manuela Merli, Filippo Maria Salvatori, Adriano De Santis, Fabrizio Fanelli, Daniela Pepino, Adolfo Francesco Attili, Plinio Rossi, Oliviero Riggio. (2004) Polytetrafluoroethylene-Covered Stent Grafts for TIPS Procedure: 1-Year Patency and Clinical Results. The American Journal of Gastroenterology 99:2, 280-285
CrossRef50
Dhiraj Tripathi, Ahmed Helmy, Kim Macbeth, Sherzad Balata, Hock F Lui, Adrian J Stanley, Doris N Redhead, Peter C Hayes. (2004) Ten years??? follow-up of 472 patients following transjugular intrahepatic portosystemic stent-shunt insertion at a single centre. European Journal of Gastroenterology & Hepatology 16:1, 9-18
CrossRef51
Pere Ginès, Mónica Guevara, Vicente Arroyo, Juan Rodés. (2003) Hepatorenal syndrome. The Lancet 362:9398, 1819-1827
CrossRef52
Bernhard Angermayr, Manfred Cejna, Franz Koenig, Franz Karnel, Franz Hackl, Alfred Gangl, Markus Peck-Radosavljevic, . (2003) Survival in patients undergoing transjugular intrahepatic portosystemic shunt: ePTFE-covered stentgrafts versus bare stents. Hepatology 38:4, 1043-1050
CrossRef53
Philippe Langlet, Sylvie Escolano, Dominique Valla, Delphine Coste-Zeitoun, Cecile Denie, Alain Mallet, Victor-Georges Levy, Dominique Franco, Jean-Pierre Vinel, Jacques Belghiti, Didier Lebrec, Jean-Marie Hay, Guy Zeitoun. (2003) Clinicopathological forms and prognostic index in Budd-Chiari syndrome. Journal of Hepatology 39:4, 496-501
CrossRef54
Ziv J. Haskal, Chet R. Rees, Ernest J. Ring, Richard Saxon, David Sacks. (2003) Reporting Standards for Transjugular Intrahepatic Portosystemic Shunts. Journal of Vascular and Interventional Radiology 14:9, S419-S426
CrossRef55
N. Hidajat, M. Kreuschner, R. Rottgen, R.-J. Schroder, S. Schmidt, R. Felix. (2003) Placement of Transjugular Intrahepatic Portosystemic Shunt Via the Left Hepatic Vein under Sonographic Guidance in a Patient with Right Hemihepatectomy. Acta Radiologica 44:4, 363-365
CrossRef56
Lauren Kaufman, Maxim Itkin, Emma E. Furth, Charmaine Stewart, Scott O. Trerotola. (2003) Detachable Balloon-modified Reducing Stent to Treat Hepatic Insufficiency after Transjugular Intrahepatic Portosystemic Shunt Creation. Journal of Vascular and Interventional Radiology 14:5, 635-638
CrossRef57
Paul K. Armstrong, Colin MacLeod. (2003) Infection of Transjugular Intrahepatic Portosystemic Shunt Devices: Three Cases and a Review of the Literature. Clinical Infectious Diseases 36:4, 407-412
CrossRef58
Janette D. Durham. (2003) TIPS in the Transplant Patient. Journal of Vascular and Interventional Radiology 14:2, P310-P315
CrossRef59
Kwang-Hun Lee, Do-Yun Lee, Jong Yoon Won, Sang Joon Park, Jae Kyu Kim, Woong Yoon. (2003) Transcaval Transjugular Intrahepatic Portosystemic Shunt: Preliminary Clinical Results. Korean Journal of Radiology 4:1, 35
CrossRef60
Arthur Kaser, Othmar Ludwiczek, Peter Waldenberger, Werner Jaschke, Wolfgang Vogel, Herbert Tilg. (2002) Endotoxin and its binding proteins in chronic liver disease: the effect of transjugular intrahepatic portosystemic shunting. Liver International 22:5, 380-387
CrossRef61
Karl August Brensing, Peter Raab, Jochen Textor, Johannes Görich, Peter Schiedermaier, Holger Strunk, Dieter Paar, Michael Schepke, Thomas Sudhop, Ulrich Spengler, Hans Schild, Tilman Sauerbruch. (2002) Prospective evaluation of a clinical score for 60-day mortality after transjugular intrahepatic portosystemic stent-shunt: Bonn TIPSS early mortality analysis. European Journal of Gastroenterology & Hepatology 14:7, 723-731
CrossRef62
A BRIGLIA. (2002) Hepatorenal syndromeDefinition, pathophysiology, and intervention. Critical Care Clinics 18:2, 345-373
CrossRef63
Emmanuel E Zervos, Alexander S Rosemurgy. (2001) Management of medically refractory ascites. The American Journal of Surgery 181:3, 256-264
CrossRef64
Pere Ginès. (2000) Diagnosis and treatment of hepatorenal syndrome. Best Practice & Research Clinical Gastroenterology 14:6, 945-957
CrossRef65
G Bodner. (2000) Color and pulsed Doppler ultrasound findings in normally functioning transjugular intrahepatic portosystemic shunts. European Journal of Ultrasound 12:2, 131-136
CrossRef66
Ramon Planas, Ramon Bataller, Juan Rodés. (2000) Hepatorenal syndrome. Current Treatment Options in Gastroenterology 3:6, 445-450
CrossRef67
J PERON, K BARANGE, P OTAL, H ROUSSEAU, J PAYEN, J PASCAL, F JOFFRE, J VINEL. (2000) Transjugular Intrahepatic Portosystemic Shunts in the Treatment of Refractory Ascites: Results in 48 Consecutive Patients. Journal of Vascular and Interventional Radiology 11:9, 1211-1216
CrossRef68
Rössle, Martin, Ochs, Andreas, Gülberg, Veit, Siegerstetter, Volker, Holl, Joseph, Deibert, Peter, Olschewski, Manfred, Reiser, Maximilian, Gerbes, Alexander L., . (2000) A Comparison of Paracentesis and Transjugular Intrahepatic Portosystemic Shunting in Patients with Ascites. New England Journal of Medicine 342:23, 1701-1707
Full Text69
J BORSA, A FONTAINE, E HOFFER, R BLOCH, E TONG, K KOWDLEY, U SCHMIEDL. (2000) Primary Placement of Palmaz Long Medium Stents in Transjugular Intrahepatic Portosystemic Shunts. Journal of Vascular and Interventional Radiology 11:2, 189-194
CrossRef70
Arun J. Sanyal. (2000) The use and misuse of transjugular intrahepatic portasystemic shunts. Current Gastroenterology Reports 2:1, 61-71
CrossRef71
Janus P. Ong, Mark Sands, Zobair M. Younossi. (2000) Transjugular Intrahepatic Portosystemic Shunts (TIPS). Journal of Clinical Gastroenterology 30:1, 14-28
CrossRef72
Naga Chalasani, W.Scott Clark, L.G. Martin, Jeffrie Kamean, M.Abdul Khan, Nilesh H. Patel, Thomas D. Boyer. (2000) Determinants of mortality in patients with advanced cirrhosis after transjugular intrahepatic portosystemic shunting. Gastroenterology 118:1, 138-144
CrossRef73
M SEHGAL, Z HASKAL. (2000) Use of Transjugular Intrahepatic Portosystemic Shunts during Lytic Therapy of Extensive Portal Splenic and Mesenteric Venous Thrombosis: Long-term Follow-up. Journal of Vascular and Interventional Radiology 11:1, 61-65
CrossRef74
P. Gentilini. (1999) Hepatorenal syndrome and ascites ? an introduction. Liver International 19:s1, 5-14
CrossRef75
M. Bernardi, L. Blendis, A. K. Burroughs, G. Laffi, J. Rodes, P. Gentilini. (1999) Hepatorenal syndrome and ascites - questions and answers. Liver International 19:s1, 15-74
CrossRef76
Karl Barange, Jean-Marie P
ron, Kamran Imani, Philippe Otal, Jean-Louis Payen, Herve Rousseau, Jean-Pierre Pascal, Francis Joffre, Jean-Pierre Vinel. (1999) Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices. Hepatology 30:5, 1139-1143
CrossRef77
G SOARES, T MURPHY. (1999) Transcaval TIPS: Indications and Anatomic Considerations
. Journal of Vascular and Interventional Radiology 10:9, 1233-1238
CrossRef78
A. Guglielmi, R. Girlanda, F. Manzoni, M. Frameglia, G. Pelosi, M. Baldin. (1999) TIPS allowing for an endoscopic mucosal resection of early gastric cancer in a cirrhotic patient with severe hypertensive gastropathy: Report of a case. Surgery Today 29:9, 902-905
CrossRef79
Melvin B. Heyman, Jeanne M. LaBerge. (1999) Role of Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Portal Hypertension in Pediatric Patients. Journal of Pediatric Gastroenterology & Nutrition 29:3, 240-249
CrossRef80
Jan P. Lerut, Pierre Goffette, Ga??tan Molle, Francine M. Roggen, Thierry Puttemans, R??ginald Brenard, Maria Cristina Morelli, Pierre Wallemacq, Bernard Van Beers, Pierre-Fran??ois Laterre. (1999) TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT AFTER ADULT LIVER TRANSPLANTATION. Transplantation 68:3, 379-384
CrossRef81
Guy Zeitoun, Sylvie Escolano, Antoine Hadengue, Nabih Azar, Mustapha El Younsi, Alain Mallet, Marie-Jeanne Boudet, Jean-Marie Hay, Serge Erlinger, Jean-Pierre Benhamou, Jacques Belghiti, Dominique Valla. (1999) Outcome of Budd-Chiari syndrome: A multivariate analysis of factors related to survival including surgical portosystemic shunting. Hepatology 30:1, 84-89
CrossRef82
Daniel Y. Sze, Thomas Vestring, Robert P. Liddell, Noriyuki Kato, Charles P. Semba, Mahmood K. Razavi, Stephen T. Kee, Michael D. Dake. (1999) Recurrent TIPS failure associated with biliary fistulae: Treatment with PTFE-covered stents. CardioVascular and Interventional Radiology 22:4, 298-304
CrossRef83
Marc Deschenes, Michel-Pierre Dufresne, Bao Bui, Daphna Fenyves, Laurent Spahr, Louise Roy, Michel Lafortune, Gilles Pomier-Layrargues. (1999) Predictors of clinical response to transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients with refractory ascites. The American Journal of Gastroenterology 94:5, 1361-1365
CrossRef84
Shadan Mansoor, Angelie Roman, Robert Weinstein. (1999) Intravascular stents do not cause microangiopathic hemolysis or thrombotic microangiopathy. Journal of Clinical Apheresis 14:3, 130-134
CrossRef85
Adrian J. Stanley, Doris N. Redhead, Ian A.D. Bouchier, Peter C. Hayes. (1998) Acute effects of transjugular intrahepatic portosystemic stent-shunt (TIPSS) procedure on renal blood flow and cardiopulmonary hemodynamics in cirrhosis. The American Journal of Gastroenterology 93:12, 2463-2468
CrossRef86
Wilhelm Nolte, Jens Wiltfang, Christian Schindler, Hans M
CrossRef87
Grigory N. Rozenblit, Louis R.M. Del Guercio, John H. Rundback, Maurice R. Poplausky, Edward Lebovics. (1998) Peritoneal-Urinary Drainage for Treatment of Refractory Ascites: A Pilot Study
CrossRef88
Ira R. Willner, Reif El-Sakr, Robert F. Werkman, W. Zachary Taylor, Caroline A. Riely. (1998) A fistula from the portal vein to the bile duct: an unusual complication of transjugular intrahepatic portosystemic shunt. The American Journal of Gastroenterology 93:10, 1952-1955
CrossRef89
James F. Trotter, Paul V. Suhocki, Don C. Rockey. (1998) Transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory ascites: effect on body weight and Child-Pugh score. The American Journal of Gastroenterology 93:10, 1891-1894
CrossRef90
D. B. Williams, R. Waugh, W. Selby. (1998) Transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of refractory ascites. Australian and New Zealand Journal of Medicine 28:5, 620-626
CrossRef91
Alexander L. Gerbes, Veit G
CrossRef92
George T. Nahass, Lynn Cornelius. (1998) Fluoroscopy-induced radiodermatitis after transjugular intrahepatic portosystemic shunt. The American Journal of Gastroenterology 93:9, 1546-1549
CrossRef93
Zobair M. Younossi, John G. McHutchison, Crystal Broussard, David Cloutier, Ali Sedghi-Vaziri. (1998) Portal Decompression by Transjugular Intrahepatic Portosystemic Shunt and Changes in Serum-Ascites Albumin Gradient. Journal of Clinical Gastroenterology 27:2, 149-151
CrossRef94
Guido O. Perez, Gabriel Contreras. (1998) The Use of Dialysis and Hemofiltration for Complications of Liver Disease. Seminars in Dialysis 11:5, 308-316
CrossRef95
Mark A. Jeffries, Sahira Kazanjian, Mark Wilson, Jeffrey Punch, Robert J. Fontana. (1998) Transjugular intrahepatic portosystemic shunts and liver transplantation in patients with refractory hepatic hydrothorax. Liver Transplantation and Surgery 4:5, 416-423
CrossRef96
Gao-Jun Teng, Michael A. Bettmann, P. Jack Hoopes, Brian L. Ermeling, Li Yang, Robert J. Wagner. (1998) Transjugular intrahepatic portosystemic shunt in a porcine model: Histologic characteristics at the early stage. Academic Radiology 5:8, 547-555
CrossRef97
Fabrizio Bar, Stefania Battista, Enrico Garello, Maurizio Grosso, Francesco Spalluto, Eugenio Zanon, Mauro Torchio, Gianpaolo Molino. (1998) Short-term effects of transjugular intrahepatic portosystemic shunt (TIPS) on functional liver plasma flow in patients with advanced cirrhosis. Liver 18:4, 245-250
CrossRef98
Thomas D. Boyer. (1998) Is transjugular intrahepatic portasystemic shunt a panacea for the complications of portal hypertension?. Hepatology 28:2, 590-592
CrossRef99
M
CrossRef100
Gareth Dulai, Devendra Vora, Antoine Hage, Paul Martin. (1998) A NOVEL COMPLICATION OF PERITONEOVENOUS SHUNT: CARDIAC TAMPONADE. The American Journal of Gastroenterology 93:8, 1379-1380
CrossRef101
Cécile Denié, Florence Vachiéry, Adrian Gadano, Philippe Sogni, Annie Elman, Richard Moreau, Dominique Valla, Didier Lebrec. (1998) Influence of transjugular intrahepatic portosystemic shunts (TIPS) on tissue oxygenation in patients with cirrhosis. Liver 18:4, 239-244
CrossRef102
Nathan M. Bass. (1998) Role of TIPS in portal hypertension: variceal bleeding and ascites. Techniques in Vascular and Interventional Radiology 1:2, 44-50
CrossRef103
J. Pidlich, M. Peck-Radosavljevic, R. Wildling, E. Lipinski, E. Hartter, K. Lenz, C. Müller, J. Lammer, S. Thurnher, C. Bieglmayer, B. Schneider, P. Ferenci, A. Gangl. (1998) Atrial natriuretic factor after transjugular intrahepatic portosystemic shunt in liver cirrhosis and ascites. European Surgery 30:3, 189-193
CrossRef104
Marta Casado, Jaume Bosch, Juan Carlos García-Pagán, Conxita Bru, Rafael Bañares, Juan Carlos Bandi, Angels Escorsell, José Manuel Rodríguez-Láiz, Rosa Gilabert, Faust Feu, Carlos Schorlemer, Antonio Echenagusia, Joan Rodés. (1998) Clinical events after transjugular intrahepatic portosystemic shunt: Correlation with hemodynamic findings. Gastroenterology 114:6, 1296-1303
CrossRef105
J. Michael Henderson, David S. Barnes, Michael A. Geisinger. (1998) Portal hypertension. Current Problems in Surgery 35:5, 383-452
CrossRef106
Robert S. Brown, Lynne Brumage, Hal F. Yee, John R. Lake, John P. Roberts, Kenneth A. Somberg. (1998) Enterococcal Bacteremia After Transjugular Intrahepatic Portosystemic Shunts (TIPS). The American Journal of Gastroenterology 93:4, 636-639
CrossRef107
Martin Rössle, Volker Siegerstetter, Michael Huber, Andreas Ochs. (1998) The first decade of the transjugular intrahepatic portosystemic shunt (TIPS): state of the art. Liver 18:2, 73-89
CrossRef108
Wolfgang Fischbach, Volker Groß, Jürgen Schölmerich, Christian Ell, Peter Layer, Wolfgang E. Fleig. (1998) Update Gastroenterologie 1997—Teil II. Medizinische Klinik 93:3, 146-164
CrossRef109
M BEHESHTI, B DOLMATCH, M JONES. (1998) Technical Considerations in Covering and Deploying a Wallstent Endoprosthesis for the Salvage of a Failing Transjugular Intrahepatic Portosystemic Shunt
CrossRef110
DAVID WILLIAMS, RICHARD WAUGH, NEIL GALLAGHER, KENNETH PERKINS, PAMELA DILWORTH, ANNE DUGGAN, WARWICK SELBY. (1998) Mortality and rebleeding following Transjugular Intrahepatic Portosystemic Stnt Shunt for variceal haemorrhage. Journal of Gastroenterology and Hepatology 13:2, 163-169
CrossRef111
AJ Stanley, HM Gilmour, S Ghosh. (1998) IS PROTEIN-LOSING ENTEROPATHY A SIGNIFICANT COMPLICATION OF PORTAL HYPERTENSION?. The American Journal of Gastroenterology 93:1, 127-128
CrossRef112
Manuela Merli, Francesco Salerno, Oliviero Riggio, Roberto de Franchis, Franco Fiaccadori, Patrizia Meddi, Massimo Primignani, Giovanni Pedretti, Alessandra Maggi, Livio Capocaccia, Andrea Lovaria, Ugo Ugolotti, Filippo Salvatori, Mario Bezzi, Plinio Rossi, . (1998) Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotherapy for the prevention of variceal bleeding in cirrhosis: A randomized multicenter trial. Hepatology 27:1, 48-53
CrossRef113
K. J. Dabos, A. J. Stanley, D. N. Redhead, R. Jalan, R C. Hayes. (1998) Efficacy of balloon angioplasty, restenting, and parallel shunt insertion for shunt insufficiency after transjugular intrahepatic portosystemic stent-shunt (TIPSS). Minimally Invasive Therapy & Allied Technologies 7:3, 287-293
CrossRef114
Bruce A. Runyon. (1998) Management of adult patients with ascites caused by cirrhosis. Hepatology 27:1, 264-272
CrossRef115
Johann Pidlich, Markus Peck-Radosavljevic, Alexander Kranz, Reinhard Wildling, Friedrich W. Winkelbauer, Johannes Lammer, Christian Mayer, Christian Müller, Günter Stix, Alfred Gangl, Herwig Schmidinger. (1998) Transjugular Intrahepatic Portosystemic Shunt and Cardiac Arrhythmias. Journal of Clinical Gastroenterology 26:1, 39-43
CrossRef116
Howard M. Richard III, James M. Cooper, Jiyong Ahn, James E. Silberzweig, Sukru H. Emre, Harold A. Mitty. (1998) Transjugular Intrahepatic Portosystemic Shunts in the Management of Budd-Chiari Syndrome in the Liver Transplant Patient with Intractable Ascites: Anatomic Considerations
CrossRef117
Rajiv Jalan, Peter C Hayes. (1997) Hepatic encephalopathy and ascites. The Lancet 350:9087, 1309-1315
CrossRef118
RAMÓN BATALLER, VICENTE ARROYO, PERE GINÈS. (1997) Management of ascites in cirrhosis. Journal of Gastroenterology and Hepatology 12:11, 723-733
CrossRef119
Richard R. Saxon, Frederick S. Keller. (1997) Technical Aspects of Accessing the Portal Vein during the TIPS Procedure
CrossRef120
Gregory S. Smith, Graham F. Barnard. (1997) Massive Volume Paracentesis (up to 41 Liters) for the Outpatient Management of Ascites. Journal of Clinical Gastroenterology 25:1, 402-403
CrossRef121
Richard R. Saxon, Hans A. Timmermans, Barry T. Uchida, Bryan D. Petersen, Kent G. Benner, John Rabkin, Frederick S. Keller. (1997) Stent-Grafts for Revision of TIPS Stenoses and Occlusions: A Clinical Pilot Study
CrossRef122
R. Jalan, A.J. Stanley, D.N. Redhead, P.C. Hayes. (1997) Shunt insufficiency after transjugular intrahepatic portosystemic stent-shunt: the whens, whys, hows and what should we do about it?. Clinical Radiology 52:5, 329-331
CrossRef123
Kenneth A. Somberg, Manuel S. Lombardero, Sharon M. Lawlor, Nancy L. Ascher, John R. Lake, Russell H. Wiesner, Rowen K. Zetterman. (1997) A CONTROLLED ANALYSIS OF THE TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT IN LIVER TRANSPLANT RECIPIENTS. Transplantation 63:8, 1074-1079
CrossRef124
Ziv J. Haskal, Chet R. Rees, Ernest J. Ring, Richard Saxon, David Sacks. (1997) Reporting Standards for Transjugular Intrahepatic Portosystemic Shunts. Journal of Vascular and Interventional Radiology 8:2, 289-297
CrossRef125
Q. Rozenblit, E. Lebovics, J. A. Savino, J. H. Rundback, S. Bashir. (1997) Observation on intrarenal and intraperitoneal pressures in patients with tense ascites: Feasibility of unassisted ascites drainage into the urinary system. Minimally Invasive Therapy & Allied Technologies 6:1, 83-86
CrossRef126
Mark D. Uhl, Daniel B. Roth, Caroline A. Riely. (1996) Transjugular intrahepatic portosystemic shunt (TIPS) for budd-chiari syndrome. Digestive Diseases and Sciences 41:7, 1494-1499
CrossRef127
Bruce L. Daniel, Jonathan M. Rubin, J. Brian Fowlkes, David M. Williams, Ronald S. Adler. (1996) The hemodynamics of transjugular intrahepatic portosystemic shunts: Investigations with Doppler sonography and development of an in vitro model. Academic Radiology 3:6, 455-462
CrossRef128
R. J. Andrade, A. Martin-Palanca, J. M. Fraile, R. Alcantara, C. Carmona, M. C. Medina, V. Muñoz, F. Melgarejo. (1996) Transjugular Intrahepatic Portosystemic Shunt for the Management of Hepatic Hydrothorax in the Absence of Ascites. Journal of Clinical Gastroenterology 22:4, 305-307
CrossRef129
Bahram Forouzandeh, Frank Konicek, John N. Sheagren. (1996) Large-Volume Paracentesis in the Treatment of Cirrhotic Patients with Refractory Ascites. Journal of Clinical Gastroenterology 22:3, 207-210
CrossRef130
Nicolas Jabbour, Albert B. Zajko, Philip D. Orons, William Irish, Fabio Bartoli, Wallis J. Marsh, Gerald D. Dodd, Luca Aldreghitti, Joann Colangelo, Jorge Rakela, John J. Fung. (1996) Transjugular intrahepatic portosystemic shunt in patients with end-stage liver disease: Results in 85 patients. Liver Transplantation and Surgery 2:2, 139-147
CrossRef131
O. Riggio, M. Merli, G. Pedretti, R. Servi, P. Meddi, R. Lionetti, P. Rossi, M. Bezzi, F. Salvatori, U. Ugolotti, F. Fiaccadori, L. Capocaccia. (1996) Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Digestive Diseases and Sciences 41:3, 578-584
CrossRef132
David J. Fillmore, Franklin J. Miller, Lorick F. Fox, James A. Disario, Christopher C. Tietze. (1996) Transjugular Intrahepatic Portosystemic Shunt: Midterm Clinical and Angiographic Follow-up
CrossRef133
Guy Roey, Kevin Moore. (1996) The hepatorenal syndrome. Pediatric Nephrology 10:1, 100-107
CrossRef134
Scott D. Kelley. (1996) Scenario number one: Discussant-Kelley. Liver Transplantation and Surgery 2:1, 72-77
CrossRef135
Thomas A. Gonwa. (1996) Scenario number one: Discussant-Gonwa. Liver Transplantation and Surgery 2:1, 70-72
CrossRef136
Ziv J. Haskal. (1996) The Complex TIPS. Journal of Vascular and Interventional Radiology 7:1, 162-167
CrossRef137
Mitchell L. Shiffman, Lennox Jeffers, Jay H. Hoofnagle, Tommie Sue Tralka. (1995) The role of transjugular intrahepatic portosystemic shunt for treatment of portal hypertension and its complications: A conference sponsored by the national digestive diseases advisory board. Hepatology 22:5, 1591-1597
CrossRef138
Florence Wong, Laurence Blendis. (1995) Transjugular intrahepatic portosystemic shunt: Is it the ultimate solution for refractory ascites?. Hepatology 22:5, 1613-1615
CrossRef139
(1995) Transjugular Intrahepatic Portosystemic Stent Shunt for Ascites. New England Journal of Medicine 333:13, 878-879
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