Stent-grafts for de novo TIPS: Technique and early results

Robert T. Andrews, Richard R. Saxon, Robert D. Bloch, Bryan D. Petersen, Barry T. Uchida, John M. Rabkin, Marc M. Loriaux, Frederick S. Keller, Josef Rösch

Research output: Contribution to journalArticle

52 Scopus citations

Abstract

PURPOSE: To evaluate the potential benefits of placing a polytetrafluoroethylene (PTFE)-covered stent-graft during initial creation of a transjugular intrahepatic portosystemic shunt (TIPS) in clinical practice. MATERIALS AND METHODS: De novo TIPS were created with a PTFE stent-graft in four male and four female patients with symptomatic portal hypertension awaiting liver transplant. Their ages ranged from 35 to 62 (mean, 47) years. Patients were followed with TIPS ultrasound (US) and/or venography until liver transplantation or death; one remains under active study. Six recovered specimens underwent gross and microscopic evaluation. RESULTS: All TIPS placements were successful. Six shunts were primarily patent, with a mean patency of 289 days, through completion of the study. Five were found to be patent at transplant and one was found to be patent at autopsy. Explant evaluation revealed a smooth, thin layer of neointima and exclusion of biliary secretions. Three patients developed a total of four stenoses (one tandem lesion) during follow-up, leading to revision in two patients. Mean primary and total patency in these patients was achieved after 279 and 463 days, respectively. A previously occult moderate stenosis was detected after explant in another patient. Only one (nonsignificant) stenosis clearly developed in an area covered by PTFE. CONCLUSION: Placement of a de novo PTFE stent-graft during TIPS creation is feasible and may extend primary shunt patency. Appropriate positioning of the stent-graft is critical.

Original languageEnglish (US)
Pages (from-to)1371-1378
Number of pages8
JournalJournal of Vascular and Interventional Radiology
Volume10
Issue number10
DOIs
StatePublished - Jan 1 1999

Keywords

  • Endovascular stent grafts
  • Shunt, portosystemic
  • Stents and prostheses

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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