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Use of fenestration to revise shunt dysfunction after transjugular intrahepatic portosystemic shunt

  • Zhaonan Li
  • De-Chao Jiao
  • Guangyan Si
  • Xinwei HanEmail author
  • Wenguang Zhang
  • Yahua Li
  • Xueliang Zhou
  • Juanfang Liu
  • Jianjian Chen
Interventional Radiology
  • 25 Downloads

Abstract

Purpose

To explore the feasibility of fenestration in the treatment of shunt dysfunction after transjugular intrahepatic portosystemic shunt (TIPS).

Methods

Between February 2012 and December 2017, 12 TIPS patients with shunt dysfunction underwent fenestration to resolve recurrent portal hypertension with gastric variceal bleeding or ascites. The demographic data, operative data, postoperative recovery data, hemodynamic data, and complications were analyzed.

Results

Twelve patients underwent TIPS revision by fenestration, with a technical success rate of 100%. After stent reconstruction, the portal vein diameters decreased gradually with time (before the procedure: at 5 days/1 month/3 months/6 months; after procedure: 1.45 ± 0.11 cm/1.38 ± 0.06 cm/1.36 ± 0.05 cm/1.34 ± 0.05 cm/1.32 ± 0.06 cm, respectively, P = 0.057). Additionally, the blood flow velocity and blood flow rapidly increased in the portal veins and shunts after TIPS revision (P < 0.001). Surprisingly, after 3 months of stent reconstruction, the portal blood flow was 4607.99 ± 1304.10 mL/min which was even lower than the shunt flow at 4651.18 ± 612.74 mL/min. The mean pressure gradient (PSG) prior to TIPS revision was 36.71 ± 3.36 mmHg which decreased to 17.42 ± 3.37 mmHg after the procedure (P < 0.001). Clinical improvement was observed in all patients after the shunt reconstruction. Three patients (25%) had mild intra-abdominal hemorrhage at 1 week after the operation. After a mean 11.0 ± 1.24 months follow-up, ascites and bleeding were well controlled, and no stenosis of the stents was found.

Conclusions

For patients with failed TIPS revision, fenestration to reconstruct the shunt provides an excellent alternative procedure, which is effective, safe, and has a certain clinical value, for continuing the treatment of portal hypertension.

Keywords

Portal hypertension Hepatic encephalopathy Cirrhosis Portography 

Abbreviations

TIPS

Transjugular intrahepatic portosystemic shunt

PVT

Portal vein thrombosis

RVB

Recurrent variceal bleeding

PSG

Portosystemic gradient

IVC

Inferior vena cava

RVB

Recurrent variceal bleeding

BC

b-Hepatitis cirrhosis

AC

Alcoholic cirrhosis

PV

Portal vein

RA

Refractory ascites

HE

Hepatic encephalopathy

FS

Fluency stent (Bard, Voisins le Bretonneux, France)

VS

Viatorr stent (Gore & Associates, Flagstaff, AZ, USA)

WS

Wall stent (Boston Scientific, Natick, MA, USA)

DIPS

Direct intrahepatic portacaval shunt

ePTFE

expanded polytetrafluoroethylene

Notes

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Interventional RadiologyFirst Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
  2. 2.Department of Interventional RadiologyThe Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical UniversityLuzhouChina
  3. 3.Institute of Interventional RadiologyFirst Affiliated Hospital of Zhengzhou UniversityZhengzhouChina

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