Korean J Radiol.  2013 Jun;14(3):423-429. 10.3348/kjr.2013.14.3.423.

Parallel Shunt for the Treatment of Transjugular Intrahepatic Portosystemic Shunt Dysfunction

• Luo X
• Nie L
• Tsauo J
• Wang Z
• Tang C
• Li X

• KMID: 1705454
• DOI: http://doi.org/10.3348/kjr.2013.14.3.423

Abstract

OBJECTIVE
To investigate the safety, efficacy and long-term patency of parallel shunts (PS) in the management of the transjugular intrahepatic portosystemic shunt (TIPS) dysfunction.
MATERIALS AND METHODS
Between March 2007 and October 2010, 18 patients (13 men and 5 women) who underwent TIPS revision with the creation of PS were evaluated retrospectively. In the first 10 patients, a 10-mm-diameter Wallgraft endoprosthesis was deployed; in the latter 8 patients, an 8-mm-diameter Fluency endoprosthesis was deployed.
RESULTS
The creation of PS was technically successful in all patients. The mean +/- standard deviation portosystemic pressure gradient before and after the procedure was 25.5 +/- 7.3 mm Hg (range, 16-37 mm Hg) and 10.9 +/- 2.3 mm Hg (range, 7-16 mm Hg), respectively. The duration of follow-up was 16.7 +/- 10.8 months (range, 6-42 months). The primary shunt patency rates at 12 months after the creation of PS was 70% with Wallgraft endoprostheses and 87.5% with Fluency endoprostheses.
CONCLUSION
TIPS revision with the creation of PS is a safe, effective and durable method for treating shunt dysfunction.

Keyword

Transjugular intrahepatic portosystemic shunt; Parallel shunt; Revision; Stent-graft

MeSH Terms

Adult
Aged
Blood Pressure Determination
Female
Humans
Male
Middle Aged
Polytetrafluoroethylene
Portasystemic Shunt, Transjugular Intrahepatic/adverse effects/*methods
Prosthesis Design
Reoperation/methods
Retrospective Studies
Stents
Polytetrafluoroethylene

Figure

• 

  Fig. 1 69-year-old man following TIPS creation with Wallgraft endoprosthesis presented with recurrent variceal bleeding. A. Direct portogram showed occluded initial stent and numerous collaterals veins. B. After PS creation with second Wallgraft endoprosthesis, portogram showed good flow through shunt, without opacification of collateral veins. C. PS dysfunction developed 13 months later, and third PS was created with Wallgraft endoprosthesis. D. Final portogram showed widely patent shunt. TIPS = transjugular intrahepatic portosystemic shunt, PS = parallel shunt

• 

  Fig. 2 40-year-old man with alcoholic liver cirrhosis and recurrent variceal bleeding. A. Initial portogram showed occluded intrahepatic portosystemic shunt. B. Final portogram after revision with PS creation showed good flow through shunt. This PS was created with Fluency endoprosthesis. PS = parallel shunt

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