HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: 2362040766v1 236/2/725    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lau, C. T. Articles by Clark, T. W. I. Search for Related Content PubMed PubMed Citation Articles by Lau, C. T. Articles by Clark, T. W. I.

Dacron-covered Stent-Grafts in Transjugular Intrahepatic Portosystemic Shunts: Initial Experience¹

¹ From the Section of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA, 19104 (C.T.L., S.W.S., M.C.S., J.A.S., T.W.I.C.); and Department of Radiology, Lankenau Hospital, Wynnewood, Pa (M.S.). Received April 28, 2004; revision requested July 12; revision received September 3; accepted October 4. Address correspondence to T.W.I.C. (e-mail: timothy.clark{at}uphs.upenn.edu).

PURPOSE: To retrospectively review the authors' experience with use of a Dacron-covered stent-graft in transjugular intrahepatic postosystemic shunts (TIPS).

MATERIALS AND METHODS: The need for internal review board approval was waived. Informed consent was obtained from all patients. The study was compliant with the Health Insurance Portability and Accountability Act. A retrospective analysis was performed of 16 patients who received a Dacron-covered stent-graft during revision or de novo creation of TIPS. There were 13 men and three women aged 44–80 years (mean age, 61 years). Primary unassisted and assisted patency rates and secondary patency rates were estimated. The primary unassisted patency of patients who underwent de novo placement of stent-grafts (n = 10) was compared with that of patients with stent-grafts placed during shunt revision (n = 6); in all patients, stent-grafts were placed within stents. Primary unassisted patency was also compared between patients in whom the covered stent was confined to the parenchymal tract (n = 7) and those in whom the stent extended 1 cm or more into the portal vein (n = 9). Patency was estimated with the Kaplan-Meier method, and group comparisons were performed with the log-rank test.

RESULTS: Primary unassisted patency rates following stent-graft placement at 4, 12, and 24 months (± standard error) were 64% ± 14, 54% ± 15, and 40% ± 16, respectively. The rates for primary assisted patency were 78% ± 12, 67% ± 14, and 67% ± 14 and those for secondary patency were 91% ± 9, 81% ± 12, and 54% ± 23. At 12 months, primary unassisted patency with de novo stent-graft placement was 90% ± 9, whereas that with stent-grafts placed during TIPS revision was 17% ± 15 (P = .005). At 12 months, the primary unassisted patency in patients with stent-grafts confined to the parenchymal tract was 75% ± 22, and that of patients with stent-grafts extending at least 1 cm into the portal vein was 40% ± 17 (P = .21).

CONCLUSION: In this small series, satisfactory long-term patency was observed among patients in whom Dacron-covered stent-grafts were placed during revision or de novo creation of TIPS. More favorable outcomes were observed when the stent-graft was placed during de novo TIPS creation and when the device was confined to the parenchymal tract.

© RSNA, 2005