Transjugular intrahepatic portosystemic shunting (TIPS) with balloon-expandable and self-expanding stents: Technical and clinical aspects after 3 1/2 years’ experience

Tesdal, I. Kaare; Jaschke, Werner; Bühler, Mathias; Adamus, R.; Filser, Thomas; Holm, Eggert; Georgi, M

doi:10.1007/s002709900105

Cited by 26 publications

(16 citation statements)

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“…Reports of the use of TIPS in these situations have shown rebleeding rates of 23%-40% after 2 years and suggest a substantial improvement in survival (3,5,(17)(18)(19)(20)(21). There is no consensus in the literature regarding the role of variceal embolotherapy during TIPS procedures (3,22), and, to our knowledge, there is no published data evaluating the combination of these two methods versus TIPS creation alone, although authors of many articles describe the use of different embolization materials during TIPS creation (3,6,17,23).…”

Section: Discussionmentioning

confidence: 95%

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Transjugular Intrahepatic Portosystemic Shunts: Adjunctive Embolotherapy of Gastroesophageal Collateral Vessels in the Prevention of Variceal Rebleeding

Tesdal¹,

Filser²,

Weiss³

et al. 2005

Radiology

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Section: Discussionmentioning

confidence: 95%

“…The technique of placing a transjugular intrahepatic stent to establish a portosystemic shunt has been described previously (3,6,12,13). The portosystemic gradient between the portal vein and right atrium was measured in centimeters of water, which we then converted to millimeters of mercury.…”

Section: Angiographic and Procedural Protocolmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunts: Adjunctive Embolotherapy of Gastroesophageal Collateral Vessels in the Prevention of Variceal Rebleeding

Tesdal¹,

Filser²,

Weiss³

et al. 2005

Radiology

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108

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“…Despite this, some studies argue that TIPS creation alone is sufficient to manage variceal gastrointestinal hemorrhage in most instances [13,14]. Patients with varices that continue to fill in spite of a post-TIPS reduction in the portosystemic gradient to less than 12 mmHg [15], patients who have large caliber portosystemic collateral vessels [13,16], patients with submucosally coursing vessels [17], and patients who have gastric varices or gastric antral vascular ectasia [18] have been cited as specific populations with increased bleeding risk that may benefit from variceal embolization. Given the lack of consensus in literature regarding the role of variceal embolotherapy during TIPS procedures in the covered stent-graft age, this study was undertaken with the purpose of comparing rebleeding rates following TIPS with concurrent coil embolization of gastroesophageal varices with TIPS alone in the Viatorr era.…”

Section: Introductionmentioning

confidence: 99%

Rebleeding rates following TIPS for variceal hemorrhage in the Viatorr era: TIPS alone versus TIPS with variceal embolization

et al. 2010

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Purpose To compare rebleeding rates following treatment of variceal hemorrhage with TIPS alone versus TIPS with variceal embolization in the covered stent-graft era. Methods In this retrospective study, 52 patients (M:F 29:23, median age 52 years) with hepatic cirrhosis and variceal hemorrhage underwent TIPS insertion between 2003 and 2008. Median Child-Pugh and MELD scores were 8.5 and 13.5. Generally, 10-mm diameter TIPS were created using covered stent-grafts (Viatorr; W.L. Gore and Associates, Flagstaff, AZ). A total of 37 patients underwent TIPS alone, while 15 patients underwent TIPS with variceal embolization. The rates of rebleeding and survival were compared. Results All TIPS were technically successful. Median portosystemic pressure gradient reductions were 13 versus 11 mmHg in the embolization and non-embolization groups. There were no statistically significant differences in Child-Pugh and MELD score, or portosystemic pressure gradients between each group. A trend toward increased rebleeding was present in the non-embolization group, where 8/37 (21.6%) patients rebled while 1/15 (6.7%) patients in the TIPS with embolization group rebled (P = 0.159) during median follow-up periods of 199 and 252 days (P = 0.374). Rebleeding approached statistical significance among patients with acute hemorrhage, where 8/32 (25%) versus 0/14 (0%) rebled in the non-embolization and embolization groups (P = 0.055). A trend toward increased bleeding-related mortality was seen in the nonembolization group (P = 0.120).Conclusions TIPS alone showed a high incidence of rebleeding in this series, whereas TIPS with variceal embolization resulted in reduced recurrent hemorrhage. The efficacy of embolization during TIPS performed for variceal hemorrhage versus TIPS alone should be further compared with larger prospective randomized trials.

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“…In the early days, stents such as balloon-expandable Palmaz stents were used with technical success rates ranging between 75% and 95% (14-16). Subsequently, self-expanding stents such as the Wallstent have been evaluated (16, 17), and more recently, stent grafts such as the VIATORR have been used (18, 19). Compared to bare-metal stents, the long-term patency rates of stent grafts are higher, as no pseudointimal hyperplasia occludes the tract lumen.…”

Section: Discussionmentioning

confidence: 99%

Implantability, Complications, and Follow-Up After Transjugular Intrahepatic Portosystemic Stent-Shunt Creation With the 6F Self-Expanding Sinus-SuperFlex-Visual Stent

et al. 2016

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BackgroundThe transjugular intrahepatic portosystemic stent-shunt (TIPSS) builds a shortcut between the portal vein and a liver vein, and represents a sophisticated alternative to open surgery in the management of portal hypertension or its complications.ObjectivesTo describe clinical experiences with a low-profile nitinol stent system in TIPSS creation, and to assess primary and long-term success.Patients and MethodsTwenty-six patients (5 females, 21 males; mean age 54.6 years) were treated using a low-profile 6F self-expanding sinus-SuperFlex-Visual stent system. The indication for TIPSS creation was refractory bleeding in 9 of the 26 patients, refractory ascites in 18 patients, and acute thrombosis of the portal vein confluence in one patient. Portosystemic pressure gradients before and after TIPSS, periprocedural and long-term complications, and the time to orthotopic liver transplantation (OLT) or death were recorded.ResultsThe portosystemic pressure gradient was significantly reduced, from 20.9 ± 6.3 mmHg before to 8.2 ± 2.3 mmHg after TIPSS creation (P < 0.001). Procedure-related complications included acute tract occlusion (n = 2), liver hematoma (n = 1), hepatic encephalopathy (n = 1), and cardiac failure (n = 1). Three of the 26 patients had late-onset TIPSS occlusion (at 12, 12, and 39 months after TIPSS creation). Three patients died within one week after the procedure due to their poor general condition (multiorgan failure, acute respiratory distress syndrome, necrotizing pancreatitis, and aspiration pneumonia). Another four patients succumbed to their underlying advanced liver disease within one year after TIPSS insertion. Seven patients underwent OLT at a mean time of 9.4 months after TIPSS creation.ConclusionThe sinus-SuperFlex-Visual stent system can be safely deployed as a TIPSS device. The pressure gradient reduction was clinically sufficient to treat the patients’ symptoms, and periprocedural complications were due to the TIPSS procedure per se rather than to the particular stent system employed in this study.

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Transjugular intrahepatic portosystemic shunting (TIPS) with balloon-expandable and self-expanding stents: Technical and clinical aspects after 3 1/2 years’ experience

Abstract: An ideal stent does not exist for TIPS, and the authors recommend combining a Palmaz stent with a flexible self-expanding stent.

Cited by 26 publications

References 29 publications

Transjugular Intrahepatic Portosystemic Shunts: Adjunctive Embolotherapy of Gastroesophageal Collateral Vessels in the Prevention of Variceal Rebleeding

Transjugular Intrahepatic Portosystemic Shunts: Adjunctive Embolotherapy of Gastroesophageal Collateral Vessels in the Prevention of Variceal Rebleeding

Rebleeding rates following TIPS for variceal hemorrhage in the Viatorr era: TIPS alone versus TIPS with variceal embolization

Implantability, Complications, and Follow-Up After Transjugular Intrahepatic Portosystemic Stent-Shunt Creation With the 6F Self-Expanding Sinus-SuperFlex-Visual Stent

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