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Vascular and Interventional Radiology |
1 From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia. Received September 10, 1998; revision requested November 3; revision received March 24, 1999; accepted June 8. Address reprint requests to the author, Department of Radiology, New York Presbyterian Hospital (Columbia Presbyterian), MHB 4-100, 177 Fort Washington Ave, New York, NY 10032.
PURPOSE: To determine whether polytetrafluoroethylene (PTFE) stent-grafts yield longer patency for creation or revision of transjugular intrahepatic portosystemic shunts (TIPS).
MATERIALS AND METHODS: Fourteen PTFE-covered Wallstents were placed in 13 patients with TIPS: seven at shunt creation and seven during revision of TIPS with one to five prior thromboses at 1 day to 1 year after initial TIPS formation. In six cases, prior to stent-graft placement persistent biliary-TIPS fistulas were demonstrated despite repeated shunt revisions with additional metallic stents.
RESULTS: All but one graft-lined TIPS were widely patent at a mean duration of venographic follow-up of 19 months (median, 17 months; range, 5–32 months). The limiting percentage of stenosis within the grafted shunts was 0%–10%. One patient developed stent-graft thrombosis; the prior biliary-TIPS fistula was seen despite the graft. A second, parallel PTFE-lined transcaval shunt was created in this patient; it was widely patent at 11-month follow-up. In two asymptomatic patients, stenoses developed in the short, nongrafted portions of the outflow hepatic veins.
CONCLUSION: PTFE stent-grafts can markedly prolong TIPS patency, potentially reducing the need for shunt follow-up and revision and the risk of recurrent symptoms associated with shunt stenosis or occlusion.
Index terms: Grafts, 95.1268 • Hypertension, portal, 95.711 • Liver, interventional procedures, 761.1269, 95.1268 • Shunts, portosystemic, 95.453 • Stents and prostheses, 95.1268 • Veins, grafts and prostheses, 95.1268
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