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Preliminary Results of a New Expanded-Polytetrafluoroethylene—Covered Stent-Graft for Transjugular Intrahepatic Portosystemic Shunt Procedures

Philippe Otal1, Tarek Smayra1, Christophe Bureau2, Jean Marc Peron2, Valérie Chabbert1, Patricia Chemla1, Francis Joffre1, Jean Pierre Vinel2 and Hervé Rousseau1

1 Radiology Department, Rangueil Hospital, 1 Ave. Jean Poulhes, 31403 Toulouse, France.
2 Gastroenterology Department, Purpan Hospital, 1, Pl. du Docteur Baylac, 31403 Toulouse, France.



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  		Fig. 1. —Drawing of a stent-graft shows bile-resistant expanded-polytetrafluoroethylene—lined segment on left side and unlined portion on right side separated by circumferential radiopaque marker band.

 


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  		Fig. 2A. —57-year-old man with esophageal variceal bleeding who underwent transjugular intrahepatic portosystemic shunt implantation between right hepatic vein and right portal branch. Venogram obtained after puncture of right portal branch.

 


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  		Fig. 2B. —57-year-old man with esophageal variceal bleeding who underwent transjugular intrahepatic portosystemic shunt implantation between right hepatic vein and right portal branch. Venogram obtained with a graded catheter after balloon dilation of parenchymal tract allows length of device to be determined.

 


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  		Fig. 2C. —57-year-old man with esophageal variceal bleeding who underwent transjugular intrahepatic portosystemic shunt implantation between right hepatic vein and right portal branch. Venogram shows stent-graft positioned between right hepatic vein and right portal branch.

 


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  		Fig. 2D. —57-year-old man with esophageal variceal bleeding who underwent transjugular intrahepatic portosystemic shunt implantation between right hepatic vein and right portal branch. Radiograph shows deployed stent-graft.

 


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  		Fig. 3. —Follow-up venogram at 6 months in 47-year-old woman with variceal bleeding shows patent, stenosis-free transjugular intrahepatic portosystemic shunt. Portosystemic pressure gradient is 2 mm Hg.

 


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  		Fig. 4. —Ischemic complication in 58-year-old man with variceal bleeding who presented with right upper quadrant pain 24 hr after placement of transjugular intrahepatic portosystemic shunt. Contrast-enhanced CT scan shows ischemic lesion of right lateral posterior segment as hypodense triangular area.

 


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  		Fig. 5A. —Histologic study of 59-year-old man after liver transplantation. Macroscopic photograph shows longitudinally cut covered stent-graft (W. L. Gore, Flagstaff, AZ), with noncovered portion (arrow) resting in portal system.

 


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  		Fig. 5B. —Histologic study of 59-year-old man after liver transplantation. Photomicrograph shows strut impingement on fibrous proliferation along albumin surface (arrows) that was prevented from gaining luminal surface by expandable-polytetrafluoroethylene—covered stent. Stent struts and thin layer of fibrin on luminal surface have been removed.

 


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  		Fig. 6. —Line graph shows Kaplan-Meier estimate of primary and secondary patency rates of transjugular intrahepatic portosystemic shunts.

 

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