TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT PROCEDURE - EFFICACY OF10-MM VERSUS 12-MM WALLSTENTS

PURPOSE: To compare results of transjugular intrahepatic portosystemic shunt (TIPS) placement with 10- and 12-mm Wallstents. MATERIALS AND M ETHODS: Forty-six TIPS procedures in 47 patients were retrospectively reviewed. Wallstents that were 10 mm in diameter were used in 23 patie nts, and those that were 12 mm in diameter were used in 23 patients. I mmediate results were compared, which included initial portosystemic g radient and Doppler measurements of blood flow velocity through the sh unt at 1 day. Long-term patency and velocities were also assessed. RES ULTS: TIPS were successfully created in 46 of 47 patients (98%). In on e patient in the 10-mm group, the portal vein could not be accessed. W hen compared with TIPS in the 10-mm group, TIPS placed in the 12-mm gr oup required dilation to larger diameters (mean, 11.1 vs 9.2 mm; P < . 0001) to achieve an identical target gradient of 10 mm Hg and exhibite d lower 1-day velocities (mean, 1.3 m/sec vs 1.7 m/sec; P < .03). The 1-day occlusion rate was 17% (four of 23 patients) in the 12-mm group versus 0% in the 10-mm group (P < .02). Patient survival was statistic ally significantly less in the 12-mm group (P < .03). CONCLUSION: Twel ve-millimeter Wallstents yield statistically significantly poorer shor t- and long-term results in TIPS procedures. This is most likely due t o the decreased radial strength of the larger stent, which is 50% less than that of the 10-mm stent.