Percutaneous inferior vena cava-to-portal vein shunt (PIPS) using a stent-graft: preliminary results.
OBJECTIVE
To present preliminary results of an inferior vena cava (IVC)-to-portal vein shunt (PIPS) that is created through the caudate lobe of the liver.


METHODS
Sixteen patients (13 men; mean age 50 years, range 32-63) were referred for PIPS procedures because of bleeding varices (n = 11), intractable ascites (n = 4), and hepatorenal syndrome (n = 1). The severity of liver disease was Child's B in 2 and Child's C in 14. The PIPS was created by a transhepatic puncture through the IVC and the portal vein; an endograft made of polytetrafluoroethylene sutured to a Palmaz stent was placed through a jugular approach.


RESULTS
In 13 (81%) patients, the portal vein-to-IVC tracts were successfully created. The postprocedural portal vein-IVC gradients varied from 1 to 9 mm Hg (mean 5). There were 2 deaths in the 30-day periprocedural period from adult respiratory distress syndrome and hepatorenal syndrome. A third patient died at 31 days from liver failure owing to continuing alcohol abuse. In addition, there was 1 case of peritoneal bleeding treated with blood product replacement. The follow-up period ranged from 14 to 671 days (mean 343). None of the patients treated for variceal bleeding had another bleeding episode, but 2 patients who had a PIPS procedure for refractory ascites did not benefit from the procedure. Postprocedure, 46% (6/13) of the patients had hepatic encephalopathy, which was unchanged from baseline. The primary and secondary patency rates at 365 days were 60% and 65%, respectively.


CONCLUSIONS
The preliminary results using a stent-graft to create an IVC-portal vein shunt are encouraging and support further work to better determine the role of this procedure.
Quinn
Stephen F
SF
Radiology Associates, P.C., Eugene, Oregon, USA. squinn@peacehealth.org
Kim
Jinho
J
Sheley
Robert C
RC
D000328:Adult; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D015641:Radiography, Interventional; D015607:Stents; D014654:Vascular Patency; D014682:Vena Cava, Inferior / Q000601:surgery*