Bidirectionally Adjustable TIPS Reduction by Parallel Stent and Stent-Graft Deployment
Received 11 March 2008; received in revised form 8 August 2008; accepted 8 August 2008. published online 26 September 2008.
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.
aDivision of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3646, Stanford, CA 94305-5642
bDivision of Hepatology, Stanford University Medical Center, 300 Pasteur Drive, H-3646, Stanford, CA 94305-5642
Address correspondence to D.Y.S.
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.
ABSTRACT