Coaxial Stent Graft inside a Constraining Stent for Transjugular Intrahepatic Portosystemic Shunt Reduction.

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Gastroenterology

Background:

• Transjugular intrahepatic portosystemic shunt (TIPS) creation is crucial for managing portal hypertension.
• TIPS revision or reduction is sometimes necessary to manage complications or optimize hemodynamics.
• Existing methods for TIPS reduction can be complex or less effective.

Purpose of the Study:

• To describe a novel technique for creating a coaxial stent graft construct for TIPS reduction.
• To evaluate the feasibility and preliminary efficacy of this technique in patients.

Main Methods:

• A coaxial, self-expanding stent graft was assembled inside a balloon-expandable stent on a back table.
• The combined construct was deployed in patients using standard unsheathing techniques.
• Six TIPS diameter reductions were performed in four patients.

Main Results:

• Successful deployment of the stent graft construct was achieved in all cases.
• Mean postreduction TIPS diameter was 6 mm (range, 0-8 mm).
• Mean portosystemic pressure gradient increased by 6 mm Hg (range, 1-19 mm Hg).
• Hepatic encephalopathy improved by 1 point on the West Haven scale (range, 0-2).

Conclusions:

• This back-table technique for creating a stent graft within a stent is feasible for TIPS reduction.
• The procedure effectively reduced TIPS diameter and improved hemodynamic parameters.
• Preliminary results suggest a positive impact on hepatic encephalopathy, warranting further investigation.