Safety and efficacy of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunts in children with acute or recurring upper gastrointestinal bleeding

• Published in: Pediatric radiology Vol. 45; no. 3; pp. 422 - 429
• Main Authors: Zurera, Luis J., Espejo, Juan J., Lombardo, Sagrario, Gilbert, Juan J., Canis, Miguel, Ruiz, Concepción
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2015; Springer Nature B.V
• Subjects: Acute Disease; Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Gastrointestinal Hemorrhage - diagnostic imaging; Gastrointestinal Hemorrhage - surgery; Humans; Imaging; Male; Medicine; Medicine & Public Health; Neuroradiology; Nuclear Medicine; Oncology; Original Article; Pediatrics; Polytetrafluoroethylene; Portasystemic Shunt, Transjugular Intrahepatic - methods; Radiology; Recurrence; Retrospective Studies; Treatment Outcome; Ultrasonography; Ultrasound; Venography; Cavernomatosis; Fluoroscopy; Intrahepatic portosystemic shunt; Child; Portal vein thrombosis; Liver transplantation
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-014-3181-z

Background
The transjugular intrahepatic portosystemic shunt (TIPS) is effective for treating complications of portal hypertension in cirrhotic adults but the experience in children is limited.
Objective
To retrospectively review the safety and efficacy of expanded polytetrafluoroethylene (ePTFE)-covered TIPS in children with acute or recurrent gastrointestinal bleeding.
Materials and methods
We reviewed the medical records of children who received implants of 10-mm-diameter PTFE-covered endoprostheses for acute or recurring upper gastrointestinal bleeding caused by medically or endoscopically uncontrollable varices. The recurrence of upper gastrointestinal bleeding, associated complications and permeability were assessed with Doppler sonography sequentially or up to transplantation.
Results
In all children (
n
 = 12; mean age 9 years; mean weight 30 kg) a single endoprosthesis was implanted with no associated mortality. The mean initial transhepatic gradient was 15 mmHg (range 3–21 mmHg), dropping to 7 mmHg (range 1–12 mmHg) after TIPS. Immediate complications were mild encephalopathy (
n
 = 1) and acute occlusion of the TIPS (
n
 = 1). Stenosis of the TIPS was observed in two children, at 9 months and 54 months follow-up, and thrombosis was observed in two children, at 7 months and 12 months follow-up. All four stenoses/occlusions were resolved with coaxial endoprostheses.
Conclusion
The safety profile and efficacy of expanded polytetrafluoroethylene (ePTFE)-covered TIPS were satisfactory in this small series of children with acute or recurrent gastrointestinal bleeding.