STENT-GRAFTS FOR REVISION OF TIPS STENOSES AND OCCLUSIONS - A CLINICAL PILOT-STUDY

PURPOSE: To assess the clinical and technical results of stent-graft p lacement for revision of transjugular intrahepatic portosystemic shunt (TIPS) stenoses and occlusions. MATERIALS AND METHODS: Six patients w ho developed recurrent TIPS stenosis or occlusion of the parenchymal t ract underwent shunt revision with use of polytetrafluoroethylene (PTF E) stent-grafts anchored at both ends by Z stents and centrally suppor ted by Wallstents. RESULTS: Before graft placement, mean primary paten cy was 50 days (range, 9-100 days), Patients underwent one to eight re visions with angioplasty or stent placement (mean, 3.2). Three patient s had biliary-TIPS fistulas documented with use of a prototype double occlusion balloon catheter. Stent-grafts were successfully placed with in the obstructed shunt, creating an excellent lumen in all cases, The portosystemic gradient was decreased from a mean of 24.3 mm Hg (range , 12-35 mm Hg) to a mean of 10.3 mm Hg (range, 7-16 mm Hg). Five of si x patients were asymptomatic and no complications occurred (median cli nical follow-up, 331 days), One patient died of pre-existing multi-org an system failure, The duration of primary patency after stent-graftin g was improved (mean, 229 days; range, 27-324 days) and the difference approached statistical significance despite the small sample size (P = .056, paired t test), Three patients remained primarily patent at a mean venographic follow-up of 315 days, One shunt occluded at 1 month from residual thrombus in the portal vein, and one stenosis occurred t hat was secondary to misplacement of the original stent-graft, Patency was re-established in each of these patients. CONCLUSION: PTFE covere d stent-grafts are effective for shunt revision in patients with tract stenosis or occlusion and appear to improve TIPS patency.