Interventional revision method on shunt dysfunction after transjugular intrahepatic portosystemic shunt using covered stents

Abstract

Objective To explore the interventional revision method on shunt dysfunction after transjugular intrahepatic portosystemic shunt (TIPS) using covered stents. Method Twenty-four patients with shunt dysfunction who underwent TIPS using covered stents between October 2009 and January 2013 were enrolled. Seventeen patients were males and 7 were females, with age ranging from 31 to 63, average 51±8. All the enrolled patients were characterized by recurrence of preoperative symptoms after first TIPS. All cases were treated by in-situ recanalization firstly, and when the guide wire and catheter was difficult to get through from the liver vein end to portal vein end, retrograde wire guiding technique was introduced through percutaneous transhepatic puncture. If all the attempts failed, parallel TIPS was employed. Oral administration of aspirin (0.1 g, 1/d) was conducted for antiplatelet therapy after surgery. Pair t-test was used to compare the portal venous pressure before and after the interventional revision. The therapeutic effect was evaluated by ultrasonic Doppler and the symptoms, such as upper gastrointestinal hemorrhage or intractable ascites. Follow up time was 27-66 months, and median time was 41 months. Results All the 24 cases were confirmed to be shunt stenosis by angiography, including 21 cases of stents-liver vein end stenosis and 3 cases of portal vein end stenosis. All the patients were examined by color Doppler ultrasound and 20 cases prompted shunt stenosis. The positive rate was 83.3%. Twenty patients were revised by in-situ recanalization and 4 patients were revised by parallel TIPS. Portal venous pressure decreased from (3.5 ± 0.4) kPa to (1.4 ± 0.4) kPa after interventional revision (t=18.3, P=0.001). Except one case of portal cavernoma rebleeding one month after the revision and missing follow up, all patients had no symptom recurrence and shunt restenosis by color doppler ultrasound. The second patency was 95.8% (23/24). Conclusions Stents-liver vein end stenosis was common among the shunt stenosis after TIPS. The interventional revision can improve the shunt dysfunction significantly. Key words: Restenosis,revise; Covered stents; Interventional radiology; Portasystemic shunt, transjugular intrahepatic