Brief ReportShould Transjugular Intrahepatic Portosystemic Shunt Stent Grafts Be Underdilated?
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.
References (14)
- et al.
TIPS: comparison of shunt patency and clinical outcomes between bare stents and expanded polytetrafluoroethylene stent-grafts
J Vasc Interv Radiol
(2009) - et al.
Results of a retrospective multicenter trial of the Viatorr expanded polytetrafluoroethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt creation
J Vasc Interv Radiol
(2004) TIPS: 25 years later
J Hepatol
(2013)- et al.
An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group
Hepatology
(1996) - et al.
TIPS for treatment of variceal hemorrhage: clinical outcomes in 128 patients at a single institution over a 12-year period
J Vasc Interv Radiol
(2012) - et al.
Quality improvement guidelines for transjugular intrahepatic portosystemic shunts
J Vasc Interv Radiol
(2003) - et al.
Hepatic Encephalopathy
Am J Gastroenterol
(2001)
Cited by (28)
Transjugular Intrahepatic Portosystemic Shunts in Pediatric Portal Hypertension: A Systematic Review and Meta-Analysis
2023, Journal of Vascular and Interventional RadiologyThe underdilation of nitinol stents at TIPS implantation: Solution or illusion?
2017, European Journal of RadiologyCitation 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 RadiologyCitation 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.
None of the authors have identified a conflict of interest.