Recurrent TIPS Failure Associated with Biliary Fistulae: Treatment with PTFE-Covered Stents
- Division of Cardiovascular and Interventional Radiology, Stanford University Medical Center, Stanford, CA 94305-1056 (United States)
- Institut fuer Klinische Radiologie, Universitaetsklinik Muenster, Albert-Schweitzer-Strasse 33, D-48149 Muenster (Germany)
- Department of Radiology, Mie University School of Medicine, 2185 Fujikata, Tsu, Mie 514 (Japan)
Purpose: To evaluate the efficacy of covered stents for the treatment of transjugular intrahepatic portosystemic shunt (TIPS) obstruction in human subjects with identified or suspected biliary fistulae. Methods: Five patients were treated for early failure of TIPS revisions. All had mid-shunt thrombus, and four of these had demonstrable biliary fistulae. Three patients also propagated thrombus into the native portal venous system and required thrombolysis. TIPS were revised in four patients using a custom-made polytetrafluoroethylene (PTFE)-covered Wallstent, and in one patient using a custom-made PTFE-covered Gianturco Z-stent. Results: All identified biliary fistulae were successfully sealed. All five patients maintained patency and function of the TIPS during follow-up ranging from 2 days to 21 months (mean 8.4 months). No patient has required additional revision. Thrombosis of the native portal venous system was treated with partial success by mechanical thrombolysis. Conclusion: Early and recurrent failure of TIPS with mid-shunt thrombosis, which may be associated with biliary fistulae, can be successfully treated using covered stents. Stent-graft revision appears to be safe, effective, and potentially durable.
- OSTI ID:
- 21080286
- Journal Information:
- Cardiovascular and Interventional Radiology, Vol. 22, Issue 4; Other Information: DOI: 10.1007/s002709900392; Copyright (c) 1999 Springer-Verlag New York Inc; Country of input: International Atomic Energy Agency (IAEA); ISSN 0174-1551
- Country of Publication:
- United States
- Language:
- English
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