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CardioVascular and Interventional Radiology

, Volume 42, Issue 1, pp 78–86 | Cite as

Transjugular Intrahepatic Portosystemic Shunt Using the New Gore Viatorr Controlled Expansion Endoprosthesis: Prospective, Single-Center, Preliminary Experience

  • Roberto Miraglia
  • Luigi MaruzzelliEmail author
  • Ambra Di Piazza
  • Giuseppe Mamone
  • Settimo Caruso
  • Giovanni Gentile
  • Fabio Tuzzolino
  • Gaetano Floridia
  • Ioannis Petridis
  • Riccardo Volpes
  • Angelo Luca
Clinical Investigation TIPS
  • 299 Downloads
Part of the following topical collections:
  1. TIPS

Abstract

Objectives

To evaluate short-term clinical efficacy, complications and possible passive stent expansion of transjugular intrahepatic portosystemic shunt (TIPS) creation using the new controlled expansion ePTFE covered stent (VCX), for portal hypertension complications.

Methods

Between 7/2016 and 3/2018, 75 patients received TIPS using VCX. Thirty-nine patients with VCX dilated with an 8-mm angioplasty balloon underwent computed tomography (CT) study during follow-up and CT data were used to measure stent diameter. The CT measurement technique was validated by ex vivo experiment.

Results

TIPS indications were: refractory ascites (n = 45), variceal bleeding (n = 22), other (n = 8). Mean follow-up was 5.8 months (± 4.5, range 1–20). In 69 patients, TIPS was dilated to 8 mm of diameter reaching the hemodynamic target of a portosystemic pressure gradient (PSG) < 12 mmHg. In six patients, not reaching the hemodynamic target the stent was dilated to 10 mm of diameter during the same session with a final PSG < 12 mmHg. Overall clinical success was achieved in 66/75 (88%) patients (80% in refractory ascites, 95% variceal bleeding, 100% other). Grade II–III encephalopathy was observed in five patients (6%). TIPS revision with stent dilatation to 10 mm was performed in seven patients: in three patients with ascites persistence, without evidence of stent dysfunction and in four patients for stent stenosis. One patient underwent stent reduction. Fourteen patients (18%) died during follow-up of causes not related to TIPS. Five patients (6%) underwent liver transplant. No passive stent expansion was detected by CT measurements.

Conclusion

VCX for TIPS creation retains its diameter over a short-term period and is associated with a good clinical outcome with a reasonably low complication rate.

Keywords

Ascites Bleeding Liver Cirrhosis Computed tomography Transjugular intrahepatic portosystemic shunt Stent 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Consent for Publication

For this type of study consent for publication is not required.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed Consent

This study has obtained IRB approval from IRCCS-ISMETT and the need for informed consent was waived.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • Roberto Miraglia
    • 1
  • Luigi Maruzzelli
    • 1
    Email author return OK on get
  • Ambra Di Piazza
    • 1
  • Giuseppe Mamone
    • 1
  • Settimo Caruso
    • 1
  • Giovanni Gentile
    • 1
  • Fabio Tuzzolino
    • 2
  • Gaetano Floridia
    • 2
  • Ioannis Petridis
    • 3
  • Riccardo Volpes
    • 3
  • Angelo Luca
    • 1
  1. 1.Radiology Service, Department of Diagnostic and Therapeutic ServicesMediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT)PalermoItaly
  2. 2.Research OfficeMediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT)PalermoItaly
  3. 3.Hepatology UnitMediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT)PalermoItaly

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