Stent-grafts in transjugular intrahepatic portosystemic shunts

Objective: To retrospectively evaluate the efficacy of polytetrafluorothylene covered nitinol stent graft (Viatorr, Gore, Flagstaff Arizona, USA) in transjugular intrahepatic portosystemic shunt (TIPS). Methods: Thirty-seven consecutive patients underwent a TIPS procedure between May 2004 and June 2006 at the Dotter Interventional Institute in Portland, Oregon, USA. The average follow-up time was (15.2±9.3)months. Indications for the procedure included recurrent variceal bleeding after attempted endoscopic management (n=17), refractory ascites or hydrothorax (n=18), and Budd-Chiari syndrome (n=2). The t test was used for statistics. Results: Forty-one stent-grafts were implanted in 37 patients, S of the devices were 8 mm in diameter and 38 were 10 mm. The covered stent length varied from 4 to 8 cm without complications. Portosystemic gradient (PSG) decresed significantly from (22.4±8.4)mm Hg (1 mm Hg=0.133 kPa) to (8.1±3.2)mm Hg, (t=12.754,P<0.01). During the follow-up period, Variceal bleeding recurrence occurred in 1 of 17 patients and for ascites or hydrothorax, two of 14 patients. Shunt occlusion occurred in 2 of 37 (5.4%) patients (4 and 17 months post-shunt). The 1-year primary patency rate was 97.0%. Two patients died from multisystem organ failure (MSOF) with a patent stent-graft during the follow-up period. Five patients were excluded from the evaluation after liver transplantation. Conclusion: TIPS created with a PTFE-covered stent (Viatorr) showed favorable patency rate and low complication rates. (authors)