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Experimental Studies |
1 From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia (Z.J.H.), and Pathology Associates International, Frederick, MD (L.H.B.). Received November 23, 1998; revision requested December 30; revision received March 24, 1999; accepted July 1. Supported in part by a research grant from Boston Scientific, Natick, Mass. Address reprint requests to Z.J.H., Department of Radiology, New York Presbyterian Hospital (Columbia Presbyterian), MHB 4-100, 177 Fort Washington Ave, New York, NY 10032.
PURPOSE: To evaluate the safety, efficacy, and tissue response associated with Wallstents covered with polyethylene terephthalate (PETP) compared with those associated with uncovered Wallstents for creation of transjugular intrahepatic portosystemic shunts (TIPS) in a porcine model.
MATERIALS AND METHODS: Thirteen TIPS were created in 13 minipigs: eight with PETP-covered Wallstents, five with standard Wallstents. Shunt venography was performed at 5–8 weeks, and necropsy was performed at 7–8 weeks. Histopathologic, immunohistochemical, and scanning electron microscopic examinations were performed.
RESULTS: Mean shunt stenoses of the control and graft groups were 45% and 53%, respectively. Graft stenoses involved the entire graft-bearing segment, whereas bare stent stenoses were localized within the liver tract. Myofibroblast and extracellular collagen matrix proliferation encompassed both control and graft-covered stents. There was one graft TIPS occlusion. One control TIPS stenosis was due to transstent proliferation of normal porcine hepatic tissue. A small focus of bile staining was seen on the abluminal surface of one TIPS, which was a patent PETP-lined shunt.
CONCLUSION: PETP graft TIPS provided equal, but not superior, patency to that of bare stent TIPS. The pattern of PETP TIPS graft healing differed from that of bare stents but was similar to that reported with other polyester graft vascular implants and consisted of diffuse transmural penetration and paving of the graft surface by extracellular collagen matrix and myofibroblasts.
Index terms: Grafts, 95.1268 • Hypertension, portal, 95.711 • Interventional procedures, experimental studies, 95.1268 • 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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