TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT WITH SILICONE-COVERED WALLSTENTS - RESULTS IN A SWINE MODEL

PURPOSE: To evaluate the use of impermeable silicone-covered Wallstent s for transjugular intrahepatic portosystemic shunt creation. MATERIAL S AND METHODS: A transjugular intrahepatic portosystemic shunt was cre ated in 14 young swine (weight, 20-32 kg) by using impermeable silicon e-covered Wallstents. In eight animals, the silicone covering extended from the portal vein to the inferior vena cava. In two swine, the sil icone covering ended short of the inferior vena cava, in two it ended short of the portal vein wall, and in two it ended short at each end. Follow-up transhepatic portal venography was performed weekly for 6 we eks or until the shunt was occluded. Animals were then sacrificed for gross and histologic evaluation. RESULTS: Only two of 14 shunts were p atent after 3 weeks; both were stenosed with luminal narrowing of more than 50% in the middle of the shunt. By 6 weeks, all shunts were occl uded. At histologic evaluation, a marked foreign-body reaction with su perimposed thrombosis was demonstrated. CONCLUSION: In comparison with uncovered Wallstents, impermeable silicone-covered Wallstents are ass ociated with decreased patency at transjugular intrahepatic portosyste mic shunt creation. This is likely due to increased thrombogenicity an d a foreign-body reaction.