J Korean Radiol Soc.  2004 Nov;51(5):507-513. 10.3348/jkrs.2004.51.5.507.

Prevention of Potential Complications Related to Transjugular Intrahepatic Portosystemic Shunt Procedure: Efficacy of Polytetrafluoroethylene Stent Grfat

Affiliations
  • 1Department of Radiology, Kyungpook National University School of Medicine, Korea. yhkim68@dsmc.co.kr
  • 2Department of Radiology, Keimyung University School of Medicine, Korea.
  • 3Department of Radiology, Andong General Hospital, Korea.
  • 4Department of Radiology, Taegu Catholic University School of Medicine, Korea.

Abstract

PURPOSE
The purpose of this study was to assess the efficacy of a polytetrafluoroethylene (PTFE) stent graft for preventing potential complications related to a transjugular intrahepatic portosystemic shunt (TIPS).
MATERIALS AND METHODS
Between January 2002 and March 2003, seven patients (males: 5, females: 2, mean age: 44) underwent TIPS stent placement using the PTFE stent graft (Nitis, Taewoong, Seoul, Korea) to prevent potential complications such as life threatening hemoperitoneum, hemobilia and early stent occlusion. Three patients were admitted for esophageal varix bleeding, three patients were admitted for gastric varix bleeding and one patient was admitted for umbilical bleeding. The extrahepatic portal vein was punctured inadvertently in four patients (main portal vein: 1 case, portal vein bifurcation: 3 cases), but contrast media extravasation into the peritoneal cavity on the tractogram was noted only in two patients. Two of four patients had chronic portal vein occlusion with intra- and extrahepatic cavernous transformation. The bile duct was inadvertently punctured and visualized on the tractogram in three patients.
RESULTS
All the identified biliary trees or contrast media extravasations observed on the tractograms were successfully sealed off on the post-procedure portograms. The immediate post-procedure clinical recovery courses were uneventful in all patients (no hemobilia or hemoperitoneum was noted). Bleeding control was successful in all patients. The one patient who had Child-Pugh class C disease died of hepatic encephalopathy 3 days after TIPS placement. Five of the six living patients have not shown any complications or rebleeding during the follow up periods (9-23 months). The one patient who had biliary communication on the tractogram re-bled due to TIPS stent stenosis 25 days after TIPS, and this patient was successfully treated by TIPS revision.
CONCLUSION
Potential complications related to TIPS procedure can be successfully prevented with PTFE stent-graft placement.

Keyword

Interventional procedures, complications; Stents and prostheses; Shunts, portosystemic

MeSH Terms

Bile Ducts
Blood Vessel Prosthesis
Constriction, Pathologic
Contrast Media
Esophageal and Gastric Varices
Extravasation of Diagnostic and Therapeutic Materials
Female
Follow-Up Studies
Hemobilia
Hemoperitoneum
Hemorrhage
Hepatic Encephalopathy
Humans
Peritoneal Cavity
Polytetrafluoroethylene*
Portal Vein
Portasystemic Shunt, Surgical*
Seoul
Stents*
Contrast Media
Polytetrafluoroethylene
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