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Adjustable diameter TIPS in the pediatric patient: the constrained technique

Brandon C Perry1, Eric J Monroe2, Giridhar Shivaram2

  • 1Department of Radiology, University of Washington School of Medicine, Washington, USA.

Diagnostic and Interventional Radiology (Ankara, Turkey)
|May 18, 2018
PubMed

Insights

We developed an adjustable transjugular intrahepatic portosystemic shunt (TIPS) for children with portal hypertension. This novel technique allows for future expansion, accommodating growth and preventing repeat procedures.

Area of Science:

  • Interventional Radiology
  • Pediatric Gastroenterology
  • Vascular Surgery

Background:

  • Transjugular intrahepatic portosystemic shunt (TIPS) is crucial for managing pediatric portal hypertension complications like variceal bleeding and ascites.
  • Standard TIPS placement in children faces challenges due to smaller anatomy and the need to accommodate future growth.
  • Existing fixed-diameter stents may lead to suboptimal hemodynamics or necessitate complex revision procedures.

Purpose of the Study:

  • To present a novel technique for creating an adjustable-diameter TIPS in pediatric patients.
  • To address the limitations of adult-sized and fixed-diameter stents in pediatric TIPS placement.
  • To provide a solution that adapts to a child's growth and evolving hemodynamic needs.

Main Methods:

  • A balloon-expandable bare metal stent is concentrically placed around a standard ePTFE TIPS endograft.
  • This creates an intentionally narrowed shunt diameter that can be adjusted via balloon dilation in subsequent procedures.
  • The technique allows for precise calibration of shunt hemodynamics as the child grows.

Main Results:

  • The described method offers a technical solution to the challenges of pediatric TIPS placement.
  • It enables future expansion of the TIPS diameter to match the child's growth.
  • This approach potentially avoids the need for additional shunt placements or complex reduction procedures.

Conclusions:

  • An adjustable-diameter TIPS is a viable and advantageous technique for pediatric patients with portal hypertension.
  • This method provides a flexible and scalable solution for managing shunt hemodynamics throughout a child's development.
  • The technique enhances the long-term management of pediatric portal hypertension, improving patient outcomes.

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