Radiology, Vol 199, 658-664, Copyright © 1996 by Radiological Society of North America
Transjugular intrahepatic portosystemic shunt procedure: efficacy of 10- mm versus 12-mm Wallstents
J Kuhn-Fulton, SO Trerotola, VJ Harris, JJ Snidow, MS Johnson, MA Carey, XH Zhou and L Lumeng
Department of Radiology, Indiana University School of Medicine, Indianapolis 46202-5253, USA.
PURPOSE: To compare results of transjugular intrahepatic portosystemic
shunt (TIPS) placement with 10- and 12-mm Wallstents. MATERIALS AND
METHODS: Forty-six TIPS procedures in 47 patients were retrospectively
reviewed. Wallstents that were 10 mm in diameter were used in 23 patients,
and those that were 12 mm in diameter were used in 23 patients. Immediate
results were compared, which included initial portosystemic gradient and
Doppler measurements of blood flow velocity through the shunt at 1 day.
Long-term patency and velocities were also assessed. RESULTS: TIPS were
successfully created in 46 of 47 patients (98%). In one patient in the
10-mm group, the portal vein could not be accessed. When compared with TIPS
in the 10-mm group, TIPS placed in the 12-mm group required dilation to
larger diameters (mean, 11.1 vs 9.2 mm; P < .0001) to achieve an
identical target gradient of 10 mm Hg and exhibited lower 1-day velocities
(mean, 1.3 m/sec vs 1.7 m/sec; P < .03). The 1-day occlusion rate was
17% (four of 23 patients) in the 12- mm group versus 0% in the 10-mm group
(P < .02). Patient survival was statistically significantly less in the
12-mm group (P < .03). CONCLUSION: Twelve-millimeter Wallstents yield
statistically significantly poorer short- and long-term results in TIPS
procedures. This is most likely due to the decreased radial strength of the
larger stent, which is 50% less than that of the 10-mm stent.
