Brief Report
Should Transjugular Intrahepatic Portosystemic Shunt Stent Grafts Be Underdilated?

https://doi.org/10.1016/j.jvir.2014.08.012Get rights and content

Abstract

Although underdilation of transjugular intrahepatic portosystemic shunt (TIPS) stent grafts is commonly performed to limit complications arising from excessive portosystemic shunting, it is uncertain whether underdilated stents retain their smaller diameter indefinitely or eventually expand to nominal caliber. In this investigation, postprocedure computed tomography (CT) was used to compare diameters of underdilated TIPSs and TIPSs expanded to a nominal diameter of 10 mm in 61 cases. The groups had comparable shunt diameters on post-TIPS imaging (9.8 mm vs 9.9 mm; P = .079), with similar incidences of hepatic encephalopathy (34% vs 20%; P = .372), indicating stent self-expansion over time, and bringing into question the advantages of underdilation for customization of shunt caliber.

Section snippets

Materials and Methods

Institutional review board approval was granted for this study, with waiver of consent for inclusion. Patients provided written informed consent for TIPS procedures.

TIPS Procedures and Adverse Events

Forty-one of 61 TIPSs (67%) were initially underdilated to 8 mm, and 20 (33%) were initially expanded with a 10-mm balloon. TIPS hemodynamic success was achieved in all cases. There was no statistically significant difference in pre-TIPS PSG (20.5 mm Hg vs 20.0 mm Hg; P = .926), post-TIPS PSG (8.0 mm Hg vs 7.0 mm Hg; P = .160), or PSG reduction (13.5 mm Hg vs 13.0 mm Hg; P = .829) between the underdilated and nominally dilated stent groups. The incidence of new or worsening postprocedure HE was

Discussion

In the present study, we investigated the expansion of underdilated VIATORR stent grafts after TIPS creation. In comparing intentionally underdilated versus nominally dilated 10-mm VIATORR lined shunts, we found that the diameters of the underdilated devices enlarged over time, reaching a CT-measured caliber comparable to those of devices dilated to the nominal 10-mm diameter at the time of TIPS creation. The predominant expansion of nearly all underdilated VIATORR stents suggests that the

Acknowledgments

The authors acknowledge the Rush University Micro-CT/Histology Core for providing instrumentation and assistance in conducting micro-CT imaging for the study.

Cited by (28)

  • The underdilation of nitinol stents at TIPS implantation: Solution or illusion?

    2017, European Journal of Radiology
    Citation Excerpt :

    Significant expansion occurred already within the first 30 days with a slightly slower expansion of the Wallstent. The second study published as a brief report in 2015 [25] included 61 patients receiving a 10 mm Viatorr stent. Groups with and without underdilation at TIPS creation were compared.

  • Prospective Evaluation of Passive Expansion of Partially Dilated Transjugular Intrahepatic Portosystemic Shunt Stent Grafts—A Three-Dimensional Sonography Study

    2017, Journal of Vascular and Interventional Radiology
    Citation Excerpt :

    However, owing to premature termination of the study, definite conclusions concerning the association of HE and TIPS stent diameter cannot be drawn. In contrast, gradual adaption of portosystemic shunting because of initial underdilation and passive expansion over the course of several weeks may be beneficial for the patient (7,18). Furthermore, the natural occurrence of pseudointimal hyperplasia may also lead to shunt diameter narrowing over time and has to be taken into account when assessing the amount of shunting clinically.

View all citing articles on Scopus

None of the authors have identified a conflict of interest.

View full text