IMPROVED TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT PATENCY WITH PTFE-COVERED STENT-GRAFTS - EXPERIMENTAL RESULTS IN SWINE

PURPOSE: To evaluate the ability of stent-grafts made with polytetrafl uoroethylene (PTFE) graft material to improve transjugular intrahepati c portosystemic shunt (TIPS) patency. MATERIALS AND METHODS: TIPS were created in 13 swine by using PTFE-covered stent-grafts. Uncovered TIP S were placed in 13 other swine. Twenty-one of 26 animals were followe d up with portal venography for 3 months or until the shunt became sev erely stenotic. Five animals without severe stenosis were sacrificed b efore 3 months because of illness. RESULTS: At 4 weeks after TIPS plac ement, nine of 13 stent-graft TIPS were patent (<50% diameter narrowin g) compared with only one patent stent in 13 uncovered TIPS. Six of 13 stent-graft TIPS remained patent until the animals were sacrificed. I n 11 of 12 uncovered TIPS, stenosis was most prominent in the parenchy mal tract. In five of seven stent-graft TIPS, stenosis was most promin ent in the hepatic vein above the end of the graft material. Bile leak s were discovered in six occluded uncovered TIPS and in two of the ste nt-graft TIPS. CONCLUSION: PTFE-covered stent-grafts significantly imp roved TIPS patency in swine (P < .01). However, stenosis in the hepati c vein led to late shunt malfunction in selected cases.