[Transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of symptomatic portal hypertension]. / Transjugulární intrahepatální portosystémový zkrat (TIPS) pri lécbe symptomatické portálni hypertenze.

BACKGROUND: A transjugular intrahepatic portosystemic shunt (TIPS) is the creation of a percutaneous portosystemic anastomosis which is used as an alternative method of surgical portosystemic shunts and endoscopic treatment in the therapy of complications of portal hypertension. The objective of the present work was to summarize experience with TIPS in 100 patients. METHODS AND RESULTS: In 1992-1995 the authors treated 100 patients with symptomatic portal hypertension by TIPS. To create the shunt in 84% patients a spiral Z stent was used, in the remainder a Wallstent. In 86% patients the indication for TIPS was haemorrhage associated with portal hypertension and in 14% refractory ascites. TIPS was implemented in 98% patients. The pressure in the portal vela was not reduced on average to 58% of the original value. Haemorrhage was not stopped in one of 7 patients. Haemorrhage from varices reappeared in 7% patients indicated on account of repeated haemorrhage and was always associated with the finding of chronic stenosis of the shunt. The mortality in conjunction with the procedure was 4%, the mortality within 30 days after operation was 8%. Uncontrollable encephalopathy developed in 3% of the patients. Primary patency of the shunt created by the spiral Z stent was 85% after 6 months, after 12 months 72% and thus does not differ from primary patency when Wallstents are used, as reported in the literature. CONCLUSIONS: TIPS is an effective method to reduce the pressure in the portal vein in portal hypertension. The main limiting factor of the method is stenosis of the shunt due to hyperplasia of the neointima. Stenoses of the shunt can be effectively dilated by percutaneous balloon angioplasty.

[Revascularization of the aortoiliac arteries using stents]. / Revaskularizace v aortoilických tepnách pomocí stentu.

The authors summarised their three year experience with endovascular treatment of the aortoiliac artery obstructive lesions using stents and transluminal angioplasty. Fifty-seven patients (61 limbs) underwent stent implantation to treat claudications (n = 50 limbs), rest pain (n = 6), non-healing defects (n = 4) and one patient was asymptomatic (n = 1). After stent placement patients were followed-up using clinical and duplex ultrasound examinations at 3 months and 6 months thereafter. Immediate angiographic success was achieved in all cases. Three serious complications were observed. Percutaneous reinterventions because of stenosis inside the stent were performed in 7 patients (7 limbs). The primary patency rates were 92% at 1 year, 88% at 2 years and 86% at 3 years. Cumulative primary assisted patency were 98% (mean follow-up 15.8 months, range 3-47 months). Regular clinical and ultrasound follow-up examinations can reveal the asymptomatic instent stenosis and percutaneous reinterventions can improve long-term stent patency.

[Interventional procedures in patients after vascular reconstructive surgery of the lower extremities]. / Intervencní výkony u nemocných po cévních rekonstrukcních operacích na dolních koncetinách.

This study reports the results and complications of local thrombolysis therapy of recently occluded grafts manifested by acute ischemia in comparison with transluminal angioplasty of graft stenoses. Stenoses were diagnosed by means of ultrasound (asymptomatic patients) or manifested by claudications. The aim of our study is to emphasize the difference between efficacy of these two kinds of treatment and their difficulties. Fourty three patients were treated in the period of 39 months (March 1994-June 1997). Sixty seven interventional procedures were done, including 32 local thrombolysis in 20 patients and 35 angioplasties in 23 patients. Types of grafts were: aortofemoral (n = 8), ilicofemoral (n = 4) and one aortotibioposterior, femoropopliteal vein (n = 18) and synthetic (n = 9) and two distal tibioposterior bypasses. Fourty one bypasses were created due to arteriosclerotic occlusion, one for traumatic amputation and one due to stenosis after perinatal catheterization. The period between surgery and intervention varied from 1 month to 11 years (mean 33 months), the mean follow up period was 13 months. Technical success rate in patients treated by local thrombolysis was 69% (n = 22). Midterm graft patency in the this group is 40% (n = 8) with 95% (n = 19) limb salvage. In patients treated by transluminal angioplasty was technical success rate 97% (n = 34). In this group is patent 96% (n = 20) bypasses with 31% (n = 4) restenoses. All patients with patent grafts have a good run-off with at least 2 patent calf arteries. Six complications occurred during local thrombolytic therapy. Our results indicate that despite of the high initial success rate are the late results poor in the group treated by thrombolysis because of the high rate of rethromboses. The result depends on number of patent calf arteries. Results in patients treated by angioplasty only are much better with lower risk of complications during procedure. Our results prove that it is better to follow patients after lower limb bypass surgery by ultrasonography and perform angioplasty when stenoses occur.

[Transjugular intrahepatic portosystemic shunt]. / Transjugulární intrahepatický portosystémový zkrat.

The transjugular intrahepatic portosystemic shunt (TIPS) is a relatively new method of creating a portosystemic shunt using a needle, angioplasty balloon catheters and expandable metallic stents. During a 6-month period, the authors have performed TIPS, using the spiral Z-stent--another modification of the Gianturco-Rósch stent--in 13 patients with portal hypertension. The procedure was technically successful in all patients. Portal pressure decreased by 6 mmHg in one group of patients with 9-10 mm stents, and by 12 mmHg in another group using 12 mm stents. Control of variceal bleeding or resolution of refractory ascites was evident in 11 of the 13 patients.