Transjugulärer intrahepatischer portosystemischer Stent-Shunt: Indikationen und Langzeitresultate

Zusammenfassung

Der transjuguläre intrahepatische Stent-Shunt (TIPS) ist ein zwischenzeitlich etabliertes und technisch ausgereiftes Verfahren mit geringer Invasivität zur effektiven Therapie von Komplikationen der portalen Hypertension, insbesondere der rezidivierenden Varizenblutung und des therapierefraktären Aszites. Für diese Indikationen hat es die chirurgische Anlage portosystemischer Shunts weitgehend verdrängt. Reinterventionen sind jedoch wegen Restenosierungsraten von 25-50 % häufig erforderlich. Die wichtigste unerwünschte Wirkung ist das Auftreten oder die Verschlechterung einer hepatischen Enzephalopathie. Neuere Studien mit Verwendung PTFE-beschichteter Stents zeigen eine geringere Stenosierungsrate und einen Trend zu verlängertem Überleben.

Abstract

The transjugular intrahepatic portosystemic stent shunt has replaced surgical shunt procedures as the standard therapy for complications of portal hypertension such as refractory ascites and recurrent variceal bleeding. However, reinterventions due to TIPS stenosis are necessary in 25-50 %. Major complications are the manifestation or worsening of hepatic encephalopathy. Recent studies using PTFE covered stents have shown lower stenosis rates and a trend towards prolonged survival.

Schlüsselwörter

portale Hypertension - TIPS - Varizenblutung - therapierefraktärer Aszites

Key words

portal hypertension - stent shunt - variceal bleeding - refractory ascites

Literatur

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