Preliminary results of a new expanded-polytetrafluoroethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt procedures.
OBJECTIVE
The purpose of our study was to evaluate the feasibility and the safety of transjugular intrahepatic portosystemic shunts (TIPS) with a new expanded-polytetrafluoroethylene-covered stent and the influence of the covering on occlusion rate.


METHODS
Twenty cirrhotic patients (57 +/- 11 years old) admitted with a history of esophageal variceal bleeding (n = 11), refractory ascites (n = 5), or both (n = 4) were included. Five of the patients were treated for TIPS revision, and 15 as de novo TIPS placements. The endoprostheses used were composed of a 2-cm noncovered nitinol stent and a 4- to 8-cm expanded-polytetrafluoroethylene graft covering, and were placed from the portal vein to the ostium of the hepatic vein. Patients underwent Doppler sonography at discharge and again at 1, 3, 6, 9, 12, and 15 months and underwent venography with portosystemic pressure gradient measurement at 6 months and whenever necessary.


RESULTS
At the time of this writing, complications included three TIPS restenoses and one recurrent ascites successfully treated by balloon dilation, two cases of segmentary liver ischemia, and one patient with encephalopathy that required shunt reduction. After TIPS placement, the portosystemic pressure gradient dropped from 18 +/- 5 to 5 +/- 4 mm Hg. Primary and secondary patency rates were 80% and 100%, respectively, at 387 days.


CONCLUSIONS
These results clearly show the feasibility of TIPS placement with the Gore TIPS endoprosthesis stent-graft and its improved patency compared with results in the literature for bare stents. These preliminary results must be certified further with randomized comparative trials between covered and noncovered TIPS stents.
Otal
Philippe
P
Radiology Department, Rangueil Hospital, 1 Ave. Jean Poulhes, 31403 Toulouse, France.
Smayra
Tarek
T
Bureau
Christophe
C
Peron
Jean Marc
JM
Chabbert
Valérie
V
Chemla
Patricia
P
Joffre
Francis
F
Vinel
Jean Pierre
JP
Rousseau
Hervé
H
D000328:Adult; D000368:Aged; D000497:Alloys; D020099:Coated Materials, Biocompatible; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D017082:Portal Pressure / Q000502:physiology; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation*; D011172:Portography; D015607:Stents; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
D000497:Alloys; D020099:Coated Materials, Biocompatible; C013616:nitinol; D011138:Polytetrafluoroethylene