Intravascular US-guided direct intrahepatic portocaval shunt with an expanded polytetrafluoroethylene-covered stent-graft

Hanno Hoppe, Stephen L. Wang, Bryan Petersen

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Purpose: To retrospectively evaluate the midterm patency rate of the nitinol (Viatorr, W.L. Gore and Associates, Flagstaff, Ariz) stent-graft for direct intrahepatic portacaval shunt (DIPS) creation. Materials and Methods: Institutional Review Board approval for this retrospective HIPAA-compliant study was obtained with waiver of informed consent. DIPS was created in 18 men and one woman (median age, 54 years; range, 45-65 years) by using nitinol polytetrafluoroethylene (PTFE)-covered stent-grafts. The primary indications were intractable ascites (n = 14), acute variceal bleeding (n = 3), and hydrothorax (n = 2). Follow-up included Doppler ultrasonography at 1, 6, and 12 months and venography with manometry at 6-month intervals after the procedure. Shunt patency and cumulative survival were evaluated by using the Kaplan-Meier method and survival curves were plotted. Differences in mean portosystemic gradients (PSGs) were evaluated by using the Student t test. Multiple regression analysis for survival and DIPS patency were performed for the following parameters: Child-Pugh class, model of endstage liver disease score, pre- and post-DIPS PSGs, pre-DIPS liver function tests, and pre-DIPS creatinine levels. Results: DIPS creation was successful in all patients. Effective portal decompression and free antegrade shunt flow was achieved in all patients. Intraperitoneal bleeding occurred in one patient during the procedure and was controlled during the same procedure by placing a second nitinol stent-graft. The primary patency rate was 100% at all times during the follow-up period (range, 2 days to 30 months; mean, 256 days; median, 160 days). Flow restrictors were deployed in two (11%) of 19 patients. The 1-year mortality rate was 37% (seven of 19). Conclusion: Patency after DIPS creation with the nitinol PTFE-covered stent-graft was superior to that after TIPS with the nitinol stent-graft.

Original languageEnglish (US)
Pages (from-to)306-314
Number of pages9
JournalRadiology
Volume246
Issue number1
DOIs
StatePublished - Jan 2008

Fingerprint

Surgical Portacaval Shunt
Polytetrafluoroethylene
Stents
Transplants
Hydrothorax
Hemorrhage
Health Insurance Portability and Accountability Act
Doppler Ultrasonography
Survival
Phlebography
Research Ethics Committees
Liver Function Tests
Manometry
Kaplan-Meier Estimate
Decompression
Informed Consent
Ascites
Liver Diseases
Creatinine
Regression Analysis

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

Intravascular US-guided direct intrahepatic portocaval shunt with an expanded polytetrafluoroethylene-covered stent-graft. / Hoppe, Hanno; Wang, Stephen L.; Petersen, Bryan.

In: Radiology, Vol. 246, No. 1, 01.2008, p. 306-314.

Research output: Contribution to journalArticle

Hoppe, Hanno ; Wang, Stephen L. ; Petersen, Bryan. / Intravascular US-guided direct intrahepatic portocaval shunt with an expanded polytetrafluoroethylene-covered stent-graft. In: Radiology. 2008 ; Vol. 246, No. 1. pp. 306-314.
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