Ces radiol. 2010, 64(2):126-132

Transjugular intrahepatic porto-systemic shunt in pediatric patientsOriginal article

Ondřej Renc¹, Antonín Krajina¹, Oldřich Pozler², Petr Hůlek³, Miroslav Lojík¹, Vendelín Chovanec¹, Jan Raupach¹, Hubert Vaniček², Tomáš Chyba², Antonín Lukeš², Vlasta Wasyliwová³

¹ Radiologická klinika LF UK a FN Hradec Králové

² Dětská klinika LF UK a FN Hradec Králové

³ 2. interní klinika LF UK a FN Hradec Králové

Aim: Transjugular intrahepatic portosystemic shunt (TIPS) creation as a solution of complications of portal hypertension in children is used quite rarely compared to the adult population, although contemporary results indicate equivalence of this method of treatment in both groups of patients. The aim of the study is to retrospectively analyse the effectivity of procedures performed in our department.

Method: In years 1992-2009, there were 21 children (10 boys, 11 girls) in the age of 3-19 years (average age 13 years) with various etiology of portal hypertension (most commonly hypercoagulable state with hepatic vein thrombosis, liver fibrosis in children with cystic fibrosis, autoimmune hepatitis) indicated for TIPS creation. Indications were variceal bleeding or ascites caused by portal hypertension. The weight of treated patiens was 12-66 kg (average weight 45 kg). All procedures were performed using standard technique from transjugular approach under general anesthesia or analgosedation with the help of TIPS-dedicated tools. Intrahepatic channel was covered by stent implantation in 12 cases. Since 2001 we decided for stentgraft implantation in the following 8 patients due to its better long-term patency. Portosystemic collateral embolisation was performed in 9 patients. TIPS patency follow-up after the procedure was based on regular ultrasonographic, clinical and laboratory examinations.

Results: Technical success rate of our procedures was 95 % and an average portosystemic gradient decrease from 18.2 mm Hg to 9.2 mm Hg was achieved. None of the patiens died during the procedure, there was only one major complication - portal vein laceration, which was treated by stentgraft insertion. The total follow-up period was 0-146 months (average period 51 months). During this interval, totally 34 TIPS revisions were performed in 10 patients, which is corresponding to 2.7 procedures per patient in the stent sub-group and 0.25 procedures per patient in the stentgraft sub-group. After the procedure, totally 5 children underwent orthotopic liver transplantation in period 0-29 months (average period 14 months) and 6 patients died during follow-up 11-96 months (average period 50 months).

Conclusion: Portosystemic shunt creation in children is a safe method in the management of complications of portal hypertension, no matter what to bridge the risk period before liver transplantation or as a definitive arrangement of portal system circulation parameters.

Keywords: child, portal hypertension, transjugular intrahepatic portosystemic shunt

Grants and funding:

Práce byla podpořena grantem IGA MZ ČR 90-20 NS10363-3/2009 a Výzkumným záměrem FN Hradec Králové MZO 00179906.

Accepted: April 15, 2010; Published: June 1, 2010  Show citation