title: Midterm follow-up of transjugular intrahepatic portosystemic shunts using polytetrafluoroethylene endografts in children.
abstract: OBJECTIVE
  To report the initial experience of a pediatric center's use of expanded polytetrafluoroethylene (ePTFE) endografts for the creation of transjugular intrahepatic portosystemic shunts (TIPSs) in children.
  
  
  METHODS
  Twelve consecutive patients had a TIPS created, all with ePTFE endografts. Nine were children younger than 18 years of age: one infant (age 18 mo) and eight adolescent children with a median age of 14 years, 3 months (range, 10 y, 1 mo, to 17 y, 2 mo). All had gastric or esophageal varices. Acute variceal bleeding was the primary indication in four of nine cases (44%). Mean follow-up was 20 months (range, 4 d to 32 mo).
  
  
  RESULTS
  Technical success rate was 100%. Seven TIPSs (78%) were created with a 10-mm-diameter endograft and two (22%) were created with an 8-mm-diameter endograft. Mean portosystemic gradient was reduced from 15.9 mm Hg to 5.8 mm Hg after TIPS creation. The devices were not dilated to their nominal diameter in seven of nine cases (78%). There were no major complications or mortalities associated with TIPS creation. There was one minor complication during follow-up in which a child developed progressively increasing lethargy. Primary patency rate by ultrasound during follow-up was 100%. There were no shunt dysfunctions or repeat interventions required, and no clinical recurrences. One child received a liver transplant 4 days after TIPS creation.
  
  
  CONCLUSIONS
  TIPSs can be created in children with the use of ePTFE endografts with an excellent midterm primary patency rate and a low complication rate.
authors.affiliation: Department of Radiology, Sections of Pediatric and Interventional Radiology, Seattle Children's Hospital, University of Washington, Seattle, Washington 98105, USA. nghia.vo@seattlechildrens.org
authors.forename: Nghia-Jack
authors.initials: NJ
authors.lastname: Vo
authors.forename: Giri
authors.initials: G
authors.lastname: Shivaram
authors.forename: Giri
authors.initials: G
authors.lastname: Shivariam
authors.forename: R Torrance
authors.initials: RT
authors.lastname: Andrews
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vaidya
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Healey
authors.forename: Simon P
authors.initials: SP
authors.lastname: Horslen
mesh_terms: D000293:Adolescent; D002648:Child; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D011138:Polytetrafluoroethylene; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000295:instrumentation*; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene