Stent-grafts in transjugular intrahepatic portosystemic shunts

Abstract

Objective To retrospectively evaluate the efficacy of polytetrafluorothylene covered nitinol stent graft (Viatorr, Gore, Flagstaff Arizona, USA) in transjugular intrahepatic partosystemic shunt (TIPS). Methods Thirty-sevan consecutive patients underwent a TIPS procedure between May 2004 and June 2006 at the Dotter Interventionsl Institute in Portland, Oregon, USA. The average follow-up time was (15.2±9.3)months. Indications for the procedure included recurrent varieeal bleeding after attempted endoscopic management (n=17), refractory ascites or hydrothorax ( n = 18 ), and Budd-Chiari syndrome (n = 2). The t test was used for statistics. Results Forty-one stent-grafts were implanted in 37 patients, 3 of the devices were 8 mm in diameter and 38 were 10 mm. The covered stent length varied from 4 to 8 cm without complications. Portosystemic gradient (PSG) decresed significantly from (22.4±8.4) mm Hg (1 nun Hg=0.133 kPa) to(8.1±3.2)mm Hg, (t = 12.754,P <0.01). During the follow-up period, Variceal bleeding recurrence occurred in 1 of 17 patients and for ascites or hydrothorax, two of 14 patients. Shunt occlusion occurred in 2 of 37 (5.4%) patients (4 and 17 months post-shunt). The 1-year primary patency rate was 97.0%. Two patients died from multisystem organ failure (MSOF) with a patent stent-graft during the follow-up period. Five patients were excluded from the evaluation after liver transplantation. Conclusion TIPS created with a PTFE-covered stent (Viatorr) showed favorable patency rate and low complication rates. Key words: Hypertension,portal; Stents; Radiology,interventional