Stepwise placement of a transjugular intrahepatic portosystemic shunt endograft.
Endografts continue to evolve the role of transjugular intrahepatic portosystemic shunts for patients with complications of portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) created with bare stents, although associated with high rates of short-term portal decompression, are plagued by shunt stenosis and thrombosis over the long term. In contrast, TIPS created with endografts achieve durable, sustained patency in most patients with portal hypertension. The technique of successful endograft placement does have technical nuances that differ from TIPS creation with bare stents. This article provides a step-by-step approach for the interventional radiologist for placement of the via Torr device, which is at currently the only US Food and Drug Administration approved endograft for TIPS. These techniques can also be applied to the creation of TIPS endografts using other off-label endograft devices.
Clark
Timothy W I
TW
Section of Vascular and Interventional Radiology, Department of Radiology, New York University School of Medicine, 560 First Avenue, HE-221, New York, NY 10016, USA. timothy.clark@med.nyu.edu
D002404:Catheterization; D004621:Embolization, Therapeutic; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000601:surgery*; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000295:instrumentation*; D011172:Portography; D011474:Prosthesis Design; D015641:Radiography, Interventional; D015607:Stents; D016896:Treatment Outcome