Improved transjugular intrahepatic portosystemic shunt patency with PTFE-covered stent-grafts: experimental results in swine.
OBJECTIVE
To evaluate the ability of stent-grafts made with polytetrafluoroethylene (PTFE) graft material to improve transjugular intrahepatic portosystemic shunt (TIPS) patency.


METHODS
TIPS were created in 13 swine by using PTFE-covered stent-grafts. Uncovered TIPS were placed in 13 other swine. Twenty-one of 26 animals were followed up with portal venography for 3 months or until the shunt became severely stenotic. Five animals without severe stenosis were sacrificed before 3 months because of illness.


RESULTS
At 4 weeks after TIPS placement, nine of 13 stent-graft TIPS were patent (< 50% diameter narrowing) compared with only one patent stent in 13 uncovered TIPS. Six of 13 stent-graft TIPS remained patent until the animals were sacrificed. In 11 of 12 uncovered TIPS, stenosis was most prominent in the parenchymal tract. In five of seven stent-graft TIPS, stenosis was most prominent in the hepatic vein above the end of the graft material. Bile leaks were discovered in six occluded uncovered TIPS and in two of the stent-graft TIPS.


CONCLUSIONS
PTFE-covered stent-grafts significantly improved TIPS patency in swine (P < .01). However, stenosis in the hepatic vein led to late shunt malfunction in selected cases.
Nishimine
K
K
Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201-3098, USA.
Saxon
R R
RR
Kichikawa
K
K
Mendel-Hartvig
J
J
Timmermans
H A
HA
Shim
H J
HJ
Uchida
B T
BT
Barton
R E
RE
Keller
F S
FS
Rösch
J
J
D000818:Animals; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control*; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000473:pathology; D011138:Polytetrafluoroethylene; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D011859:Radiography; D015607:Stents / Q000009:adverse effects; D013552:Swine
D011138:Polytetrafluoroethylene