TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTING (TIPS) WITH BALLOON-EXPANDABLE AND SELF-EXPANDING STENTS - TECHNICAL AND CLINICAL ASPECTS AFTER 3 1 2 YEARS EXPERIENCE/

Purpose: To evaluate prospectively our experience with transjugular in trahepatic portosystemic shunt (TIPS) using four different metallic st ents. Methods: Between November 1991 and April 1995, 57 patients (41 m en and 16 women; age 35-72 years, mean 54 years) underwent the TIPS pr ocedure. Techniques for portal vein localization before and during TIP S were fluoroscopy, computed tomography (CT) studies, wedged hepatic v enography, arterial portography, and ultrasound, After predilation we deployed balloon-expandable (n = 48) and self-expanding (n = 45) metal lic stents. Fifteen patients underwent variceal embolization. Initial follow-up angiograms (mean 6.9 months, range 3-24 months) were obtaine d in 39 of these patients. Results: Fifty-three patients (93%) had suc cessful TIPS placement. The mean decrease in portal pressure was 42.7% . Besides fluoroscopy, the most helpful techniques for portal vein loc alization were venography and CT. Residual stenosis (n = 1) and late s hortening (n = 4) of Wallstents resulted in shunt dysfunction. The tec hnical problems encountered with the Palmaz stent resulted from its la ck of flexibility. We combined balloon-expandable and self-expanding s tents in 12 patients. The 30-day and late follow-up (mean 11.9 months) percutaneous reintervention rates were 11.3% and 64.2%, respectively, There were no clinically significant complications related to the TIP S insertions. Conclusion: An ideal stent does not exist for TIPS, and the authors recommend combining a Palmaz stent with a flexible self-ex panding stent.