Journal of Vascular and Interventional Radiology
Volume 19, Issue 11 , Pages 1653-1658, November 2008

Bidirectionally Adjustable TIPS Reduction by Parallel Stent and Stent-Graft Deployment

  • Daniel Y. Sze, MD, PhD

      Affiliations

    • Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3646, Stanford, CA 94305-5642
    • Corresponding Author InformationAddress correspondence to D.Y.S.
    • ,
  • Gloria L. Hwang, MD

      Affiliations

    • Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3646, Stanford, CA 94305-5642
    • ,
  • Jeffrey S. Kao, MSEE

      Affiliations

    • Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3646, Stanford, CA 94305-5642
    • ,
  • Joan K. Frisoli, MD, PhD

      Affiliations

    • Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3646, Stanford, CA 94305-5642
    • ,
  • Stephen T.W. Kee, MD

      Affiliations

    • Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3646, Stanford, CA 94305-5642
    • ,
  • Mahmood K. Razavi, MD

      Affiliations

    • Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3646, Stanford, CA 94305-5642
    • ,
  • Aijaz Ahmed, MD

      Affiliations

    • Division of Hepatology, Stanford University Medical Center, 300 Pasteur Drive, H-3646, Stanford, CA 94305-5642

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.

Abbreviation: TIPS, transjugular intrahepatic portosystemic shunt

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 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.

PII: S1051-0443(08)00727-6

doi:10.1016/j.jvir.2008.08.011

Journal of Vascular and Interventional Radiology
Volume 19, Issue 11 , Pages 1653-1658, November 2008

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