TIPS with Expanded Polytetrafluoroethylene–Covered Stent: Results of an Italian Multicenter Study
Claudio Vignali1,
Irene Bargellini1,
Maurizio Grosso2,
Giovanni Passalacqua3,
Franco Maglione4,
Fulvio Pedrazzini2,
Pietro Filauri3,
Raffaella Niola4,
Roberto Cioni1 and
Pasquale Petruzzi1
1 Division of Diagnostic and Interventional Radiology, Department of Oncology,
Transplants, and Advanced Technologies in Medicine, University of Pisa, Via
Roma 67, Pisa 56127, Italy.
2 Department of Radiology, S. Croce e Carle Hospital, Via Coppino 26, Cuneo
12100, Italy.
3 Department of Radiology, Santissimi Filippo e Nicola Hospital, Località
Tre Conche, Avezzano 67051, Italy.
4 Department of Radiology, Cardarelli Hospital, Via A. Cardarelli no. 9, Napoli
80131, Italy.
View larger version (121K):
[in a new window]
|
Fig. 1A —18-year-old man with portal vein thrombosis and variceal
bleeding (patient 3, Table 2).
Patient had previously undergone splenectomy for lymphoma. Angiographic images
in anteroposterior projection demonstrate transjugular intrahepatic
portosystemic shunt procedure. Left portal vein was punctured under
sonographic and fluoroscopic guidance, and injection of contrast material
showed presence of portal cavernoma with opacification of right portal branch
(A, arrow). Track was created between right hepatic vein and
right portal branch (B), and Viatorr stent-graft (diameter, 10 mm;
length, 80 mm; W. L. Gore and Associates) was successfully deployed
(C), with reduction of portosystemic pressure gradient from 19 to 7 mm
Hg.
|
|
View larger version (162K):
[in a new window]
|
Fig. 1B —18-year-old man with portal vein thrombosis and variceal
bleeding (patient 3, Table 2).
Patient had previously undergone splenectomy for lymphoma. Angiographic images
in anteroposterior projection demonstrate transjugular intrahepatic
portosystemic shunt procedure. Left portal vein was punctured under
sonographic and fluoroscopic guidance, and injection of contrast material
showed presence of portal cavernoma with opacification of right portal branch
(A, arrow). Track was created between right hepatic vein and
right portal branch (B), and Viatorr stent-graft (diameter, 10 mm;
length, 80 mm; W. L. Gore and Associates) was successfully deployed
(C), with reduction of portosystemic pressure gradient from 19 to 7 mm
Hg.
|
|
View larger version (137K):
[in a new window]
|
Fig. 1C —18-year-old man with portal vein thrombosis and variceal
bleeding (patient 3, Table 2).
Patient had previously undergone splenectomy for lymphoma. Angiographic images
in anteroposterior projection demonstrate transjugular intrahepatic
portosystemic shunt procedure. Left portal vein was punctured under
sonographic and fluoroscopic guidance, and injection of contrast material
showed presence of portal cavernoma with opacification of right portal branch
(A, arrow). Track was created between right hepatic vein and
right portal branch (B), and Viatorr stent-graft (diameter, 10 mm;
length, 80 mm; W. L. Gore and Associates) was successfully deployed
(C), with reduction of portosystemic pressure gradient from 19 to 7 mm
Hg.
|
|
View larger version (131K):
[in a new window]
|
Fig. 1D —18-year-old man with portal vein thrombosis and variceal
bleeding (patient 3, Table 2).
Patient had previously undergone splenectomy for lymphoma. Phlebographic
control images obtained 6 months after procedure show severe stenosis of
portal vein, distal to stent-graft margin (D). Patient was
asymptomatic, but high portosystemic pressure gradient was observed (20 mm
Hg). Memotherm stent (diameter, 12 mm; length, 80 mm; Bard Peripheral
Vascular) was successfully deployed (E). Stent-graft was patent and
patient asymptomatic at 34 months' follow-up.
|
|
View larger version (126K):
[in a new window]
|
Fig. 1E —18-year-old man with portal vein thrombosis and variceal
bleeding (patient 3, Table 2).
Patient had previously undergone splenectomy for lymphoma. Phlebographic
control images obtained 6 months after procedure show severe stenosis of
portal vein, distal to stent-graft margin (D). Patient was
asymptomatic, but high portosystemic pressure gradient was observed (20 mm
Hg). Memotherm stent (diameter, 12 mm; length, 80 mm; Bard Peripheral
Vascular) was successfully deployed (E). Stent-graft was patent and
patient asymptomatic at 34 months' follow-up.
|
|
View larger version (10K):
[in a new window]
|
Fig. 2 —Kaplan-Meier analysis for primary patency. Cumulative primary
patency rate at 24 months' follow-up was 75.9%. Dotted lines indicate
confidence intervals.
|
|
View larger version (134K):
[in a new window]
|
Fig. 3A —42-year-old man with Budd-Chiari syndrome and variceal
bleeding (patient 13, Table 2).
Angiograms show success of transjugular intrahepatic portosystemic shunt
(TIPS) procedure performed with Viatorr stent-graft (diameter, 10 mm; length,
80 mm; W. L. Gore and Associates) (A). One year after treatment,
patient underwent MDCT for ascites; complete stent-graft occlusion was
observed (B, multiplanar reformation in coronal plane) associated with
incomplete track coverage at level of hepatic vein (C), volume
rendering in coronal-oblique plane). Catheterization of stent-graft was not
feasible, requiring creation of a new track; angiography after placement of
TIPS showed correct deployment of Viatorr stent-graft (diameter, 10 mm;
length, 70 mm) followed by coil embolization of a large varix (D).
|
|
View larger version (78K):
[in a new window]
|
Fig. 3B —42-year-old man with Budd-Chiari syndrome and variceal
bleeding (patient 13, Table 2).
Angiograms show success of transjugular intrahepatic portosystemic shunt
(TIPS) procedure performed with Viatorr stent-graft (diameter, 10 mm; length,
80 mm; W. L. Gore and Associates) (A). One year after treatment,
patient underwent MDCT for ascites; complete stent-graft occlusion was
observed (B, multiplanar reformation in coronal plane) associated with
incomplete track coverage at level of hepatic vein (C), volume
rendering in coronal-oblique plane). Catheterization of stent-graft was not
feasible, requiring creation of a new track; angiography after placement of
TIPS showed correct deployment of Viatorr stent-graft (diameter, 10 mm;
length, 70 mm) followed by coil embolization of a large varix (D).
|
|
View larger version (133K):
[in a new window]
|
Fig. 3C —42-year-old man with Budd-Chiari syndrome and variceal
bleeding (patient 13, Table 2).
Angiograms show success of transjugular intrahepatic portosystemic shunt
(TIPS) procedure performed with Viatorr stent-graft (diameter, 10 mm; length,
80 mm; W. L. Gore and Associates) (A). One year after treatment,
patient underwent MDCT for ascites; complete stent-graft occlusion was
observed (B, multiplanar reformation in coronal plane) associated with
incomplete track coverage at level of hepatic vein (C), volume
rendering in coronal-oblique plane). Catheterization of stent-graft was not
feasible, requiring creation of a new track; angiography after placement of
TIPS showed correct deployment of Viatorr stent-graft (diameter, 10 mm;
length, 70 mm) followed by coil embolization of a large varix (D).
|
|
View larger version (149K):
[in a new window]
|
Fig. 3D —42-year-old man with Budd-Chiari syndrome and variceal
bleeding (patient 13, Table 2).
Angiograms show success of transjugular intrahepatic portosystemic shunt
(TIPS) procedure performed with Viatorr stent-graft (diameter, 10 mm; length,
80 mm; W. L. Gore and Associates) (A). One year after treatment,
patient underwent MDCT for ascites; complete stent-graft occlusion was
observed (B, multiplanar reformation in coronal plane) associated with
incomplete track coverage at level of hepatic vein (C), volume
rendering in coronal-oblique plane). Catheterization of stent-graft was not
feasible, requiring creation of a new track; angiography after placement of
TIPS showed correct deployment of Viatorr stent-graft (diameter, 10 mm;
length, 70 mm) followed by coil embolization of a large varix (D).
|
|
View larger version (8K):
[in a new window]
|
Fig. 4 —Kaplan-Meier analysis for survival. Mean expected survival
was 21.9 months, with 59.3% cumulative overall survival at 24 months'
follow-up.
|
|
View larger version (10K):
[in a new window]
|
Fig. 5 —Kaplan-Meier analysis for survival grouped by Child-Pugh
class. Survival rate was 100% in patients with Child-Pugh class A and was
significantly higher for class A than for class B or C (log-rank test,
p = 0.0004).
|
|
View larger version (11K):
[in a new window]
|
Fig. 6 —Kaplan-Meier analysis for survival grouped by postprocedural
encephalopathy. Survival rate was significantly higher in patients without
postprocedural encephalopathy (log-rank test, p = 0.008).
|
|
View larger version (10K):
[in a new window]
|
Fig. 7 —Kaplan-Meier analysis for survival grouped by main indication
for placement of transjugular intrahepatic portosystemic shunt (variceal
bleeding or refractory ascites). Survival rate was significantly higher in
patients who underwent shunt placement for variceal bleeding than in those
with refractory ascites (log-rank test, p =0.02).
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2005 by the American Roentgen Ray Society.
