title: Use of balloon-expandable stents in transjugular intrahepatic portosystemic shunts in cases of Wallstent endoprosthesis technical failure and revision of shunt stenosis.
abstract: Thirteen patients underwent placement of a balloon-expandable stent either at initial transjugular intrahepatic portosystemic shunt (TIPS) creation (n = 3) because of immediate technical failure of the Wallstent or at shunt revision because of failure of the Wallstent to reduce the portosystemic gradient <or=12 mm Hg despite overdilation (n = 2), stenosis of the Wallstent (n = 1), or parenchymal tract shunt stenosis (n = 7). The mean duration of primary patency when balloon-expandable stents were used at initial shunt creation was 162.7 days +/- 110.1 (SD). The time from initial TIPS creation or shunt revision with a Wallstent to placement of a balloon-expandable stent was 88.6 days +/- 115.3. The time from balloon-expandable stent placement to shunt revision (n = 6), most recent follow-up (n = 2), death (n = 1), or liver transplantation (n = 1) was 171.9 days +/- 121.6. No significant difference in shunt patency was found between the Wallstent and balloon-expandable stent (P =.31). Because no added benefit in patency was seen between the balloon-expandable stent and Wallstent, it appears that balloon-expandable stent placement is valuable only when placement of a Wallstent technically fails as a result of its limited radial force or when precision in placement is needed to treat a hepatic vein stenosis near the confluence with the inferior vena cava.
authors.affiliation: Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Kuhlman
authors.forename: Nilesh H
authors.initials: NH
authors.lastname: Patel
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Johnson
authors.forename: Himanshu
authors.initials: H
authors.lastname: Shah
authors.forename: Jan
authors.initials: J
authors.lastname: Namyslowski
authors.forename: Michael S
authors.initials: MS
authors.lastname: Stecker
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Johnson
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents