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CardioVascular and Interventional Radiology

, Volume 22, Issue 4, pp 298–304 | Cite as

Recurrent TIPS failure associated with biliary fistulae: Treatment with PTFE-covered stents

  • Daniel Y. Sze
  • Thomas Vestring
  • Robert P. Liddell
  • Noriyuki Kato
  • Charles P. Semba
  • Mahmood K. Razavi
  • Stephen T. Kee
  • Michael D. Dake
Clinical Investigations

Abstract

Purpose: To evaluate the efficacy of covered stents for the treatment of transjugular intrahepatic portosystemic shunt (TIPS) obstruction in human subjects with identified or suspected biliary fistulae.

Methods: Five patients were treated for early failure of TIPS revisions. All had mid-shunt thrombus, and four of these had demonstrable biliary fistulae. Three patients also propagated thrombus into the native portal venous system and required thrombolysis. TIPS were revised in four patients using a custom-made polytetrafluoroethylene (PTFE)-covered Wallstent, and in one patient using a custom-made PTFE-covered Gianturco Z-stent.

Results: All identified biliary fistulae were successfully sealed. All five patients maintained patency and function of the TIPS during follow-up ranging from 2 days to 21 months (mean 8.4 months). No patient has required additional revision. Thrombosis of the native portal venous system was treated with partial success by mechanical thrombolysis.

Conclusion: Early and recurrent failure of TIPS with midshunt thrombosis, which may be associated with biliary fistulae, can be successfully treated using covered stents. Stent-graft revision appears to be safe, effective, and potentially durable.

Key words

Stents and prostheses Portosystemic shunt, transjugular intrahepatic Biliary fistula Hypertension, portal Portal vein, thrombosis Thrombolysis 

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Copyright information

© Springer-Verlag 1999

Authors and Affiliations

  • Daniel Y. Sze
    • 1
  • Thomas Vestring
    • 2
  • Robert P. Liddell
    • 1
  • Noriyuki Kato
    • 3
  • Charles P. Semba
    • 1
  • Mahmood K. Razavi
    • 1
  • Stephen T. Kee
    • 1
  • Michael D. Dake
    • 1
  1. 1.Division of Cardiovascular and Interventional RadiologyStanford University Medical CenterStanfordUSA
  2. 2.Institut fuer Klinische RadiologieUniversitaetsklinik MuensterMuensterGermany
  3. 3.Department of RadiologyMie University School of MedicineTsu, MieJapan

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