Brief report
Bidirectionally Adjustable TIPS Reduction by Parallel Stent and Stent-Graft Deployment

https://doi.org/10.1016/j.jvir.2008.08.011Get rights and content

Excessive shunting through transjugular intrahepatic portosystemic shunts (TIPS) can cause life-threatening hepatic encephalopathy and insufficiency. Intentional reduction of flow may be effective but difficult to control. The present report describes refinements of the parallel stent/stent-graft technique of flow reduction that is adjustable in either direction. Six patients underwent TIPS reduction with varying stent positioning and a variety of commercial products. Flow was adjusted by iterative balloon dilatation of the stent and stent-graft, resulting in a mean gradient increase of 8 mm Hg. All cases were technically successful, but 1-year survival was seen in only the patient who underwent liver transplantation.

Section snippets

Materials and Methods

Patient data were handled in accordance with the Health Insurance Portability and Accountability Act. The institutional review board granted exemption from obtaining consent for this retrospective report.

Results

The TIPS reduction procedure was successfully performed in all six cases (ie, 100% technical success rate), reestablishing venographically evident hepatopetal flow in intrahepatic portal veins. The portosystemic gradient was increased by a mean and median of 8 mm Hg (Table 1), for a final gradient (mean and median) of 17 mm Hg (range 10–20 mm Hg). All devices tested functioned adequately, and length of bare stent did not appear to affect function. Subtle differences between stent-graft designs

Discussion

Multiple methods of TIPS reduction have previously been described and reviewed (6). Flow lumen reduction with the use of covered stents rather than bare stents offers the advantage of a more predictable and immediate effect on the flow dynamics through the TIPS. However, most techniques described have the limitation that, after the stent-graft is deployed, the diameter of the waist cannot be adjusted, particularly in the direction of further flow reduction. To address this issue, we developed

Cited by (35)

  • Percutaneous shunt reduction for the management of TIPS-induced acute liver decompensation: A follow-up study

    2016, Annals of Hepatology
    Citation Excerpt :

    The rationale of TIPS reduction is to narrow the shunt flow lumen while preserving its patency, thereby increasing portal blood perfusion of the liver. The technique of TIPS reduction is the same as described for the interventional radiological management of TIPS-induced hepatic encephalopathy.7 –10 The purpose of this study was to characterise the technical, haemodynamic, laboratory and clinical outcomes of TIPS reduction in the treatment of TIPS-induced acute liver decompensation.

  • Techniques for Transjugular Intrahepatic Portosystemic Shunt Reduction and Occlusion

    2016, Techniques in Vascular and Interventional Radiology
    Citation Excerpt :

    Its diameter should match the diameter of the existing TIPS shunt, which in most cases is 10 mm. Sze et al14 have advocated utilization of the PTE-covered Wallgraft (Boston Scientific) as the stent compresses in a cylindrical manner, compared with a variety of polytetrafluoroethylene (PTFE)-covered stent grafts (Viabahn & Viatorr; WL Gore / Non-Flair Flair; Bard) that tend to assume nonsymmetrical shapes with adjacent compression. The principal objection to using the Wallgraft is diminished patency compared to PTFE-covered stents.

View all citing articles on Scopus

From the SIR 2007 Annual Meeting.

D.Y.S. is a paid consultant to MediGene, Inc. (San Diego, California), Jennerex Biotherapeutics, Inc. (San Francisco, California), and Pain Therapeutics, Inc (San Mateo, California). None of the authors have identified a conflict of interest.

View full text