title: ePTFE-covered stent-grafts for revision of obstructed transjugular intrahepatic portosystemic shunt.
abstract: OBJECTIVE
  To determine whether transjugular intrahepatic portosystemic shunt (TIPS) revisions with the Hemobahn stent-graft or the Viatorr endoprosthesis increase secondary patency rates.
  
  
  METHODS
  Between 1998 and June 1999, Hemobahn endoprostheses (W.L. Gore, Flagstaff, AZ, USA) were used for the revision of obstructed TIPS in seven patients, 51-67 years of age (mean 59 years). From June 1999 to 2000, the Viatorr endoprosthesis (W.L. Gore, Flagstaff, AZ, USA) was used for revision of obstructed TIPS in nine patients, 33-64 years of age (mean 49 years). Follow-up included duplex ultrasound, clinical assessment and venous portography.
  
  
  RESULTS
  The technical success rate of TIPS revision with the Hemobahn stent-graft was 100%. The pressure gradient decreased from a mean of 20 mmHg to 10 mmHg. The mean follow-up was 407 days (range 81-868 days). In two patients TIPS occlusion occurred at 62 and 529 days after stent-graft placement, respectively; in another two patients outflow tract stenosis occurred at 275 and 393 days, respectively. The technical success rate of TIPS revision with the Viatorr endoprosthesis was also 100%. The pressure gradient decreased from a mean of 27 mmHg to 11 mmHg. At a mean follow-up of 201 days (range 9-426 days), all Viatorr endoprostheses are still patent without in-graft stenosis, but angioplasty was required in two patients to treat a portosystemic pressure gradient > 15 mmHg. Four of the nine patients in the Viatorr group suffered from new encephalopathy after TIPS revision.
  
  
  CONCLUSIONS
  The Viatorr endoprosthesis yielded optimal results with 100% in-graft patency rates at follow-up but had a high incidence of new encephalopathy, whereas the use of Hemobahn stent-graft for TIPS revision did not appear to improve the secondary patency rates in our series.
authors: Department of Radiology, Division of Angiography and Interventional Radiology, Wahringer Gürtel 18-20, A-1090 Vienna, Austria. manfred.cejna@univie.ac.at
authors: Manfred
authors: M
authors: Cejna
authors: Markus
authors: M
authors: Peck-Radosavljevic
authors: Siegfried
authors: S
authors: Thurnher
authors: Maria
authors: M
authors: Schoder
authors: Thomas
authors: T
authors: Rand
authors: Bernhard
authors: B
authors: Angermayr
authors: Johannes
authors: J
authors: Lammer
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D011446:Prospective Studies; D012086:Reoperation; D015607:Stents / Q000009:adverse effects*
chemical_list: D011138:Polytetrafluoroethylene