title: Bidirectionally adjustable TIPS reduction by parallel stent and stent-graft deployment.
abstract: 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.
authors.affiliation: Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3646, Stanford, CA 94305-5642, USA. dansze@stanford.edu
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Sze
authors.forename: Gloria L
authors.initials: GL
authors.lastname: Hwang
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Kao
authors.forename: Joan K
authors.initials: JK
authors.lastname: Frisoli
authors.forename: Stephen T W
authors.initials: ST
authors.lastname: Kee
authors.forename: Mahmood K
authors.initials: MK
authors.lastname: Razavi
authors.forename: Aijaz
authors.initials: A
authors.lastname: Ahmed
mesh_terms: 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