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Bidirectionally adjustable TIPS reduction by parallel stent and stent-graft deployment.

Daniel Y Sze1, Gloria L Hwang, Jeffrey S Kao

  • 1Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3646, Stanford, CA 94305-5642, USA. dansze@stanford.edu

Journal of Vascular and Interventional Radiology : JVIR
|October 1, 2008
PubMed
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Transjugular intrahepatic portosystemic shunts (TIPS) flow reduction using parallel stent techniques can be adjusted. However, long-term survival remains a significant challenge, with liver transplantation showing better outcomes.

Area of Science:

  • Interventional Radiology
  • Hepatology
  • Vascular Surgery

Background:

  • Transjugular intrahepatic portosystemic shunts (TIPS) are used to treat portal hypertension.
  • Excessive shunting through TIPS can lead to severe hepatic encephalopathy and liver insufficiency.
  • Current methods for reducing TIPS flow are often difficult to control precisely.

Purpose of the Study:

  • To describe refinements in the parallel stent/stent-graft technique for adjustable TIPS flow reduction.
  • To evaluate the efficacy and adjustability of this technique in patients with excessive TIPS shunting.

Main Methods:

  • Six patients with excessive TIPS shunting underwent flow reduction using a parallel stent/stent-graft technique.
  • Adjustments were made via iterative balloon dilatation of the stents and stent-graft.

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  • Various commercial stent and stent-graft products were utilized.

    • Main Results:

    • The technique allowed for adjustable reduction of TIPS flow.
    • A mean portosystemic gradient increase of 8 mm Hg was achieved.
    • All procedures were technically successful.

    Conclusions:

    • Refined parallel stent/stent-graft techniques offer adjustable control over TIPS shunting.
    • While technically successful, the long-term survival benefit of this technique alone is questionable.
    • Liver transplantation remains a superior option for long-term survival in this patient cohort.