Transjugular Intrahepatic Portosystemic Shunt Flow Reduction with Adjustable Polytetrafluoroethylene-covered Balloon-expandable Stents

• Published in: Journal of vascular and interventional radiology Vol. 20; no. 7; pp. 981 - 986
• Main Authors: Kroma, Ghazwan, MD, Lopera, Jorge, MD, PhD, Cura, Marco, MD, Suri, Rajeev, MD, El-Merhi, Fadi, MD, Reading, Jerad, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2009
• Subjects: Catheterization - instrumentation; Coated Materials, Biocompatible - chemistry; Equipment Design; Equipment Failure Analysis; Female; Humans; Male; Middle Aged; Polytetrafluoroethylene - chemistry; Portasystemic Shunt, Transjugular Intrahepatic - instrumentation; Prosthesis Implantation - instrumentation; Radiology; Stents; transjugular intrahepatic portosystemic shunt; polyethylene terephthalate; PTFE; PET; polytetrafluoroethylene; TIPS
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2009.03.042

Creation of a transjugular intrahepatic portosystemic shunt (TIPS) can effectively treat complications of portal hypertension, but excessive shunting can cause life-threatening hepatic encephalopathy and hepatic insufficiency. The present report describes a novel technique that allows for controlled and adjustable flow reduction through the TIPS via partial closure of the shunt with a balloon-mounted covered stent. The method results in clinical improvement of hepatic encephalopathy and hepatic insufficiency and immediate increase in the portosystemic pressure gradient. However, among the four patients described herein, survival beyond 1 year was seen in only one, who underwent liver transplantation after TIPS reduction.