ePTFE-Covered Stent-Grafts for Revision of Obstructed Transjugular Intrahepatic Portosystemic Shunt

Journal Article · Tue Oct 15 04:00:00 EDT 2002 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-001-0121-8· OSTI ID:21083417

Cejna, Manfred ^[1]; Peck-Radosavljevic, Markus ^[2]; Thurnher, Siegfried; Schoder, Maria; Rand, Thomas ^[3]; Angermayr, Bernhard ^[4]; Lammer, Johannes ^[3]

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1. Department of Radiology, Division of Angiography andInterventional Radiology, Wahringer Guertel 18-20, A-1090 Vienna (Austria)
2. Departmentof Gastroenterology and Hepatology, Waehringer Guertel 18-20, A-1090 Vienna (Austria)
3. Department of Radiology, Division of Angiography and Interventional Radiology, Wahringer Guertel 18-20, A-1090 Vienna (Austria)
4. Departmentof Gastroenterology and Hepatology, Waehringer Guertel18-20, A-1090 Vienna (Austria)

Purpose: To determine whether transjugular intrahepatic portosystemic shunt (TIPS) revisions with the Hemobahn stent-graft or the Viatorr endoprosthesis increase secondary patency rates. Methods: Between 1998 and June 1999,Hemobahn endoprostheses (W.L. Gore, Flagstaff, AZ, USA) were used for the revision of obstructed TIPS in seven patients, 51-67 years of age(mean 59 years). From June 1999 to 2000, the Viatorr endoprosthesis(W.L. Gore, Flagstaff, AZ, USA) was used for revision of obstructed TIPS in nine patients, 33-64 years of age (mean 49 years). Follow-up included duplex ultrasound, clinical assessment and venousportography. Results: The technical success rate of TIPS revision with the Hemobahn stent-graft was 100%. The pressure gradient decreased from a mean of 20 mmHg to 10 mmHg. The mean follow-up was 407 days (range 81-868 days). In two patients TIPS occlusion occurred at 62 and 529 days after stent-graft placement, respectively; in another two patients outflow tract stenosis occurred at 275 and 393 days,respectively. The technical success rate of TIPS revision with the Viatorr endoprosthesis was also 100%. The pressure gradient decreased from a mean of 27 mmHg to 11 mmHg. At a mean follow-up of 201 days(range 9-426 days), all Viatorr endoprostheses are still patent without in-graft stenosis, but angioplasty was required in two patients to treat a portosystemic pressure gradient > 15 mmHg. Four of the nine patients in the Viatorr group suffered from new encephalopathy after TIPS revision. Conclusion: The Viatorrendoprosthesis yielded optimal results with 100% in-graft patency rates at follow-up but had a high incidence of new encephalopathy,whereas the use of Hemobahn stent-graft for TIPS revision did not appear to improve the secondary patency rates in our series.

• OSTI ID: 21083417
• Journal Information: Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 5 Vol. 25; ISSN 0174-1551; ISSN CAIRDG
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BLOOD PRESSURE
BYPASSES
GRAFTS
PATIENTS
PRESSURE GRADIENTS
VASCULAR DISEASES