We evaluated the efficacy of the VIATORR endoprosthesis for the management of transjugular intrahepatic portosystemic shunt (TIPS) dysfunction.
Twelve consecutive patients (10 men and two women, mean age 52.7 years) with recurrent TIPS dysfunction underwent TIPS revision with use of the VIATORR endoprosthesis. Nine patients were asymptomatic and three patients had developed recurrent variceal bleeding. All patients had previous shunt revisions (mean 2.1 revisions per patient) with angioplasty or bare stents. Follow-up included clinical assessment, Doppler ultrasound, and portal venography.
TIPS revision was successful in all patients, without complications. The mean portosystemic pressure gradient decreased from 16.8 ± 2.7 mmHg to 6.5 ± 2.6 mmHg. Hemostasis was achieved in all three patients who had recurrent variceal bleeding at the time of the procedure. Mean follow-up was 21.9 ± 10.7 months. In two patients TIPS dysfunction occurred at 14 and 30 months after stent-graft placement, respectively. The primary patency rates were 100% after 12 months and 88.8% after 24 months. Two patients (16.6%) developed encephalopathy after stent graft placement.
TIPS revision using the VIATORR endoprosthesis appears to be an effective and durable method to control shunt dysfunction.
Hypertension, portal Liver, interventional procedures Shunts, portosystemic Stents and prostheses Veins, grafts and prostheses
Papatheodoridis GV, Goulis J, Leandro G, et al. Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding: a meta-analysis. Hepatology 1999;30:612–622CrossRefPubMedGoogle Scholar
Rossle M, Ochs A, Gulberg V, et al. A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N Engl J Med 2000;342:1701–1707CrossRefPubMedGoogle Scholar
Hausegger KA, Sternthal HM, Klein GE, et al. Transjugular intrahepatic portosystemic shunt: follow-up and secondary interventions. Radiology 1994;191:177–181PubMedGoogle Scholar
Haskal ZJ, Pentecost MJ, Soulen MC, et al. Transjugular intrahepatic portosystemic shunt stenosis and revision: early and midterm results. AJR 1994;163:439–444PubMedGoogle Scholar
LaBerge JM, Somberg KA, Lake JR, et al. Two-year outcome following transjugular intrahepatic portosystemic shunt for variceal bleeding: results in 90 patients. Gastroenterology 1995;108:1143–1151CrossRefPubMedGoogle Scholar
Sterling KM, Darcy MC. Stenosis of transjugular intrahepatic portosystemic shunts: presentation and management. AJR 1997;168:239–244PubMedGoogle Scholar
Casado M, Bosch J, Garcia-Pagan JC, et al. Clinical events after transjugular intrahepatic portosystemic shunt: correlation with hemodynamic findings. Gastroenterology 1998;114:1296–1303CrossRefPubMedGoogle Scholar
Nishimine K, Saxon RR, Kichikawa K, et al. Improved transjugular intrahepatic portosystemic shunt patency with PTFE-covered stent-grafts: experimental results in swine. Radiology 1995;196:341–347PubMedGoogle Scholar
Haskal ZJ, Davis A, McAllister A, Furth EE. PTFE-encapsulated endovascular stent-graft for transjugular intrahepatic portosystemic shunts: experimental evaluation. Radiology 1997;205:682–688PubMedGoogle Scholar
Andrews RT, Saxon RR, Bloch RD, et al. Stent-grafts for de novo TIPS: technique and early results. J Vasc Interv Radiol 1999;10:1371–1378PubMedGoogle Scholar
Cejna M, Peck-Radosavijevic M, Thurnher SA, et al. Creation of transjugular intrahepatic portosystemic shunts with stent-grafts: initial experiences with a polytetrafluoroethylene-covered nitinol endoprosthesis. Radiology 2001;221:437–446PubMedGoogle Scholar
Otal P, Smayra T, Bureau C, et al. Preliminary results of a new expanded-polytetrafluoroethylene-covered stent-graft for transjugular intrahepatic shunt procedures. AJR 2002;178:141–147PubMedGoogle Scholar
Hausegger KA, Karnel F, Georgieva B, et al. Transjugular intrahepatic portosystemic shunt creation with the Viatorr expanded polytetrafluoroethylene-covered stent-graft. J Vasc Interv Radiol 2004;15:239–248PubMedGoogle Scholar
Bureau C, Garcia-Pagan JC, Otal P, et al. Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS: results of a randomized study. Gastroenterology 2004;126:469–475CrossRefPubMedGoogle Scholar
Disalle RS, Dolmatch BL. Treatment of TIPS stenosis with ePTFE graft-covered stents. Cardiovasc Interv Radiol 1998;21:172–175CrossRefGoogle Scholar
Cohen GS, Young HY, Ball DS. Stent-graft as treatment for TIPS-biliary fistula. J Vasc Interv Radiol 1996;7:665–668PubMedCrossRefGoogle Scholar
Saxon RR, Timmermans HA, Uchida BT, et al. Stent-grafts for revision of TIPS stenoses and occlusions: a clinical pilot study. J Vasc Interv Radiol 1997;8:539–548PubMedGoogle Scholar
Sze DY, Vestring T, Liddell RP, et al. Recurrent TIPS failure associated with biliary fistulae: treatment with PTFE-covered stents. Cardiovasc Interv Radiol 1999;22:298–304CrossRefGoogle Scholar
Haskal ZJ. Improved patency of transjugular intrahepatic portosystemic shunts in humans: creation and revision with PTFE stent-grafts. Radiology 1999;213:759–766PubMedGoogle Scholar
Haskal ZJ, Weintraub JL, Susman J. Recurrent TIPS thrombosis after polyethylene stent-graft. Use and salvage with polytetrafluoroethylene stent-grafts. J Vasc Interv Radiol 2002;13:1255–1259PubMedGoogle Scholar
Cejna M, Peck-Radosavijevic M, Thurnher S, et al. ePTFE-covered stent-grafts for revision of obstructed transjugular intrahepatic portosystemic shunt. Cardiovasc Interv Radiol 2002;25:365–372CrossRefGoogle Scholar
Ducoin H, El-Khoury J, Rousseau H, et al. Histopathologic analysis of transjugular intrahepatic portosystemic shunts. Hepatology 1997;25:1064–1069CrossRefPubMedGoogle Scholar
Latimer J, Bawa SM, Rees CJ, et al. Patency and reintervention rates during routine TIPSS surveillance. Cardiovasc Interv Radiol 1998;21:234–239CrossRefGoogle Scholar