Transjugular intrahepatic portosystemic shunt with expanded-polytetrafuoroethylene-covered stents in non-cirrhotic patients with portal cavernoma.
OBJECTIVE
To evaluate the feasibility and efficacy of Transjugular intrahepatic portosystemic shunt (TIPS) in non-cirrhotic patients with symptomatic portal hypertension secondary to portal cavernoma.


METHODS
Our cohort includes 13 consecutive patients. Eleven were considered for Transjugular intrahepatic portosystemic shunt placement for complications not manageable by medical/endoscopic treatment and two because of the need of oral anticoagulation in presence of high-risk varices. Expanded-polytetrafluoroethylene-covered stents were used in all.


RESULTS
One of the 13 patients was excluded because of a thrombosis of the superior cava and jugular veins. In 10 patients, Transjugular intrahepatic portosystemic shunt was successfully implanted [83.3%; 95% confidence interval: 52-98%]. One patient had an early shunt dysfunction with recurrence of variceal bleeding which required an emergency surgical shunt. Late shunt dysfunction occurred in two patients, successfully treated with angioplasty and re-stenting. Two patients experienced an episode of encephalopathy.


CONCLUSIONS
Transjugular intrahepatic portosystemic shunt is feasible in most of the patients with portal cavernoma and should be considered in those with severe complications uncontrolled by conventional therapy. The use of Transjugular intrahepatic portosystemic shunt to achieve a lifelong anticoagulation therapy in selected patients with high-risk varices may be another possible indication. These patients should be referred to selected Units with large experience in Transjugular intrahepatic portosystemic shunt placement.
Fanelli
Fabrizio
F
Dipartimento di Scienze Radiologiche, "Sapienza" Università di Roma, Italy.
Angeloni
Stefania
S
Salvatori
Filippo Maria
FM
Marzano
Chiara
C
Boatta
Emanuele
E
Merli
Manuela
M
Rossi
Plinio
P
Attili
Adolfo Francesco
AF
Ridola
Lorenzo
L
Cerini
Federica
F
Riggio
Oliviero
O
D000328:Adult; D005260:Female; D006392:Hemangioma, Cavernous / Q000150:complications / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011169:Portal Vein / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation* / Q000379:methods*; D015607:Stents; D013927:Thrombosis; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000601:surgery*
D011138:Polytetrafluoroethylene