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Creation of Transjugular Intrahepatic Portosystemic Shunts with Stent-Grafts: Initial Experiences with a Polytetrafluoroethylene-covered Nitinol Endoprosthesis¹

¹ From the Department of Radiology, Division of Angiography and Interventional Radiology (M.C., S.A.T., K.H., M.S., J.L.) and Department of Gastroenterology and Hepatology (M.P.R.), University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Received December 20, 2000; revision requested February 14, 2001; revision received March 16; accepted April 30. Address correspondence to M.C. (e-mail: manfred.cejna@univie.ac.at).

PURPOSE: To evaluate the safety and performance of a recently developed expanded polytetrafluoroethylene (ePTFE)-covered nitinol stent-graft to create transjugular intrahepatic portosystemic shunt (TIPS) in patients with portal hypertension and related complications.

MATERIALS AND METHODS: The ePTFE-covered nitinol stent-graft was used to create TIPS in 16 patients with recurrent variceal bleeding (n = 13) or refractory ascites (n = 3). Follow-up was performed with duplex ultrasonography, clinical assessment, and venography at 6 months. Technical success and portosystemic pressure gradients (PPGs) before and after stent-graft implantation and at follow-up were assessed. Two patients died during follow-up. Histopathologic follow-up data were available for one patient at autopsy and for the other after liver transplantation.

RESULTS: The implantation technical success rate was 100%. Mean (± SD) PPG was reduced from 24 mm Hg ± 5 to 9 mm Hg ± 2. Histopathologic analysis of the explanted endoprostheses revealed no inflammatory response or neointima formation. The venographic follow-up data available for 10 patients demonstrated 100% in-graft patency (mean follow-up, 289 days ± 26). Revisions with implantation of a new ePTFE-covered nitinol stent-graft or another commercially available stent in 10 patients were necessary because of hepatic vein stenosis above the grafted portion and/or relative diameter mismatch causing TIPS dysfunction.

CONCLUSION: The ePTFE-covered nitinol stent-graft was used successfully to create TIPS and has the potential to prolong TIPS patency upon complete coverage to the hepatocaval junction.

Index terms: Hypertension, portal, 95.711 • Liver, interventional procedures, 761.1269, 95.1268 • Shunts, portosystemic, 95.453 • Stents and prostheses, 95.1268 • Venography, 95.124

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