Transjugular intrahepatic portosystemic shunt: angiographic follow-up and secondary interventions.

Hausegger, K. A.; Sternthal, H M; Klein, G; Karaic, R.; Stauber, Rudolf; Zenker, G

doi:10.1148/radiology.191.1.8134566

Cited by 80 publications

(26 citation statements)

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“…Stenosis and occlusion of shunts are often encountered and repeat interventions become necessary [3][4][5][6]. The healing process after vascular injury is formation of a neointima, often manifest as and characterized by the migration of platelets and macrophages, following migration and proliferation of smooth muscle cells, formation of an endothelial cell lining, and deposition of an extracellular matrix [7].…”

mentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt: Histologic and Immunohistochemical Study of Autopsy Cases

Terayama

Matsui

Kadoya

et al. 1997

Cardiovasc Intervent Radiol

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mentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt: Histologic and Immunohistochemical Study of Autopsy Cases

Terayama

Matsui

Kadoya

et al. 1997

Cardiovasc Intervent Radiol

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“…The conclusion of this comparative study was a statistically significantly higher survival rate of patients undergoing e-PTFE-covered TIPS than patients treated with a bare stent. Comparing the survival [19] 13.4 18 (2-43.5) Rousseau [17] 22 7.2±5 Rossi [16] 5 >1 Domagk [13] 14.4 8.4 stents, and patency rates were assessed mainly by duplex ultrasound examination, not by invasive venography and pressure measurements [2].…”

Section: Discussionmentioning

confidence: 99%

“…Luca et al [1] described in a meta-analysis from 11 relevant studies an overall weighted recurrent bleeding rate of 21%; the median rate of shunt dysfunction was 55%. Hausegger et al [2] performed invasive venography at 6-month intervals, or if Doppler ultrasound showed an abnormality. They found abnormalities in the shunt in 80% of cases.…”

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confidence: 99%

Early and long-term clinical and radiological follow-up results of expanded-polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunt procedures

Maleux

Nevens

Wilmer³

et al. 2004

Eur Radiol

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The purpose of this study was to assess the therapeutic efficacy and immediate and long-term safety of expanded-tetrafluoroethylene covered stent-grafts for transjugular intrahepatic portosystemic shunts in patients with portal hypertension-related complications. A cohort of 56 patients suffering from severe portal hypertension-related complications underwent implantation of an expanded-polytetrafluoroethylene-covered stent-graft. All patients suffered from severe liver cirrhosis graded Child-Pugh A (n=8; 16%), B (n=13; 21%) or C (n=35; 63%). In 44 patients, the stent-graft was placed during the initial TIPS procedure (de novo TIPS); in the other 12 patients, the stent-graft was placed to repermeabilize the previously placed bare stent (TIPS revision). Follow-up was performed with clinical assessment, duplex ultrasound and, if abnormal or inconclusive, with invasive venography and pressure measurements. Per- en immediate post-procedural complications occurred in four patients (4/56, 7%). None of them was lethal. During follow-up, stent occlusion appeared in one patient and stenosis in two; no recurrence of bleeding was noted in all patients treated for variceal bleeding (n=28), and 24 of the 28 patients (86%) suffering from refractory ascites and/or hepatic hydrothorax were free of regular paracenteses and/or drainage of pleural effusion after shunt creation. The 30-day and global mortality for the total study population (n=56) was, respectively, 7% (n=4) and 28.5% (n=16). In the patient subgroup with variceal bleeding (n=28), 30-day mortality was 3.5% (n=1) and global mortality 14.2% (n=4). In the ascites and/or hydrothorax subgroup (n=28), 8.1% (n=3) mortality at 30 days was found and global mortality was 32.4% (n=12). In 10 patients of the 56 studied patients (18%), isolated hepatic encephalopathy occurred, which was lethal in 4 (Child C) patients (7%). Three of these four patients died within the 1st month after TIPS placement. A very high primary patency rate of TIPS can be obtained long-term after implantation of an e-PTFE-covered stent-graft, leading to a definitive resolution of portal hypertension-related complications. The incidence of TIPS-induced hepatic encephalopathy is acceptable.

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“…When early shunt dysfunction is discovered, an underlying technical etiology is often implicated, such as incomplete stent coverage of the parenchymal tract or sharp angulation, either within a long parenchymal tract or between the end of the stent and the portal or hepatic vein wall [3,[6][7][8]. In the first case described, an acute midstent stenosis developed in what appeared to be a technically satisfactory shunt.…”

Section: Discussionmentioning

confidence: 99%

Treatment of TIPS Stenosis with ePTFE Graft-Covered Stents

DiSalle

Dolmatch

1998

Cardiovasc Intervent Radiol

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Midshunt stenosis and recurrent variceal bleeding occurred in 2 patients after transjugular intrahepatic portosystemic shunts (TIPS). Repeat angioplasty was performed in both cases but recurrent stenosis again led to hemorrhage. Expanded polytetrafluoroethylene (ePTFE) graft-covered stents were expanded in each of the TIPS at the midshunt, reducing the portosystemic gradient for both patients. Variceal bleeding ceased, and follow-up studies showed no evidence of recurrent stenosis in either case.

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Transjugular intrahepatic portosystemic shunt: angiographic follow-up and secondary interventions.

Abstract: Stenosis and occlusion of TIPS may be common during long-term follow-up. Regular examinations may demonstrate abnormalities early. An abnormality seen on the shunt venogram usually can be revised during the same procedure.

Cited by 80 publications

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Transjugular Intrahepatic Portosystemic Shunt: Histologic and Immunohistochemical Study of Autopsy Cases

Transjugular Intrahepatic Portosystemic Shunt: Histologic and Immunohistochemical Study of Autopsy Cases

Early and long-term clinical and radiological follow-up results of expanded-polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunt procedures

Treatment of TIPS Stenosis with ePTFE Graft-Covered Stents

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