Recurrent TIPS failure associated with biliary fistulae: treatment with PTFE-covered stents.
OBJECTIVE
To evaluate the efficacy of covered stents for the treatment of transjugular intrahepatic portosystemic shunt (TIPS) obstruction in human subjects with identified or suspected biliary fistulae.


METHODS
Five patients were treated for early failure of TIPS revisions. All had mid-shunt thrombus, and four of these had demonstrable biliary fistulae. Three patients also propagated thrombus into the native portal venous system and required thrombolysis. TIPS were revised in four patients using a custom-made polytetrafluoroethylene (PTFE)-covered Wallstent, and in one patient using a custom-made PTFE-covered Gianturco Z-stent.


RESULTS
All identified biliary fistulae were successfully sealed. All five patients maintained patency and function of the TIPS during follow-up ranging from 2 days to 21 months (mean 8.4 months). No patient has required additional revision. Thrombosis of the native portal venous system was treated with partial success by mechanical thrombolysis.


CONCLUSIONS
Early and recurrent failure of TIPS with mid-shunt thrombosis, which may be associated with biliary fistulae, can be successfully treated using covered stents. Stent-graft revision appears to be safe, effective, and potentially durable.
Sze
D Y
DY
Division of Cardiovascular and Interventional Radiology, Stanford University Medical Center, Stanford, CA 94305-1056, USA.
Vestring
T
T
Liddell
R P
RP
Kato
N
N
Semba
C P
CP
Razavi
M K
MK
Kee
S T
ST
Dake
M D
MD
D001658:Biliary Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002648:Child; D020099:Coated Materials, Biocompatible; D004932:Esophageal and Gastric Varices / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D012449:Safety; D015607:Stents; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
D020099:Coated Materials, Biocompatible; D005343:Fibrinolytic Agents; D011138:Polytetrafluoroethylene