Stent-grafts for revision of TIPS stenoses and occlusions: A clinical pilot study

Richard R. Saxon, Hans A. Timmermans, Barry T. Uchida, Bryan D. Petersen, Kent G. Benner, John Rabkin, Frederick S. Keller

Research output: Contribution to journalArticle

84 Scopus citations

Abstract

PURPOSE: To assess the clinical and technical results of stent-graft placement for revision of transjugular intrahepatic portosystemic shunt (TIPS) stenoses and occlusions. MATERIALS AND METHODS: Six patients who developed recurrent TIPS stenosis or occlusion of the parenchymal tract underwent shunt revision with use of polytetrafluoroethylene (PTFE) stent- grafts anchored at both ends by Z stents and centrally supported by Wallstents. RESULTS: Before graft placement, mean primary patency was 50 days (range, 9-100 days). Patients underwent one to eight revisions with angioplasty or stent placement (mean, 3.2). Three patients had biliary-TIPS fistulas documented with use of a prototype double occlusion balloon catheter. Stent-grafts were successfully placed within the obstructed shunt, creating an excellent lumen in all cases. The portosystemic gradient was decreased from a mean of 24.3 mm Hg (range, 12-35 mm Hg) to a mean of 10.3 mm Hg (range, 7-16 mm Hg). Five of six patients were asymptomatic and no complications occurred (median clinical follow-up, 331 days). One patient died of pre-existing multi-organ system failure. The duration of primary patency after stent-grafting was improved (mean, 229 days; range, 27-324 days) and the difference approached statistical significance despite the small sample size (P = .056, paired t test). Three patients remained primarily patent at a mean venographic follow-up of 315 days. One shunt occluded at 1 month from residual thrombus in the portal vein, and one stenosis occurred that was secondary to misplacement of the original stent- graft. Patency was re-established in each of these patients. CONCLUSION: PTFE covered stent-grafts are effective for shunt revision in patients with tract stenosis or occlusion and appear to improve TIPS patency.

Original languageEnglish (US)
Pages (from-to)539-548
Number of pages10
JournalJournal of Vascular and Interventional Radiology
Volume8
Issue number4
DOIs
StatePublished - Jan 1 1997

Keywords

  • Liver, interventional procedure
  • Shunts, portosystemic
  • Stents and prostheses

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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