Bidirectionally adjustable TIPS reduction by parallel stent and stent-graft deployment.
Excessive shunting through transjugular intrahepatic portosystemic shunts (TIPS) can cause life-threatening hepatic encephalopathy and insufficiency. Intentional reduction of flow may be effective but difficult to control. The present report describes refinements of the parallel stent/stent-graft technique of flow reduction that is adjustable in either direction. Six patients underwent TIPS reduction with varying stent positioning and a variety of commercial products. Flow was adjusted by iterative balloon dilatation of the stent and stent-graft, resulting in a mean gradient increase of 8 mm Hg. All cases were technically successful, but 1-year survival was seen in only the patient who underwent liver transplantation.
Sze
Daniel Y
DY
Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3646, Stanford, CA 94305-5642, USA. dansze@stanford.edu
Hwang
Gloria L
GL
Kao
Jeffrey S
JS
Frisoli
Joan K
JK
Kee
Stephen T W
ST
Razavi
Mahmood K
MK
Ahmed
Aijaz
A
D000368:Aged; D001807:Blood Vessel Prosthesis; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation* / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome