Post–Transjugular Intrahepatic Portosystemic Shunt Follow-Up and Management in the VIATORR Era

Ferral, Héctor; Gómez-Reyes, E.; Fimmel, Claus J.

doi:10.1053/j.tvir.2016.01.009

Cited by 22 publications

(15 citation statements)

References 49 publications

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“…TIPS failure can either be due to stent occlusion or stenosis, which has become significantly less frequent with the widespread use of covered stents[14,18,19]. This complication can be diagnosed with Doppler imaging and confirmed during TIPS revision procedure[20-24].…”

Section: Discussionmentioning

confidence: 99%

Parallel transjugular intrahepatic portosystemic shunt with Viatorr^® stents for transjugular intrahepatic portosystemic shunt insufficiency: A case report and review of literature

Raissi

Nisiewicz

et al. 2019

WJH

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BACKGROUND Transjugular intrahepatic portosystemic shunts (TIPS) can alleviate complications of portal hypertension such as ascites and variceal bleeding by decreasing the portosystemic gradient. In limited clinical situations, parallel TIPS may be only solution to alleviate either variceal bleeding or ascites secondary to portal hypertension when the primary TIPS fails to do so. Data specifically addressing the use of this partially polytetrafluoroethylene covered nitinol stent (Viatorr ® ) is largely lacking despite Viatorr ® being the current gold standard for modern TIPS placement. CASE SUMMARY All three patients had portal hypertension and already had a primary Viatorr ® TIPS placed previously. All patients have undergone failed endoscopy to manage acute variceal bleeding before referral for a parallel stent (PS). PS were placed in patients presenting with recurrent variceal bleeding despite existence of a widely patent primary TIPS. Primary stent patency was verified with either Doppler ultrasound or intra-procedural TIPS stent venography. Doppler ultrasound follow-up imaging demonstrated complete patency of both primary and parallel TIPS. All three patients did well on clinical follow-up of up to six months and no major complications were recorded. A review of existing literature on the role of PS in the management of portal hypertension complications is discussed. There are three case reports of use of primary and PS Viatorr ® stents placement, only one of which is in a patient with gastrointestinal variceal bleeding despite a patent primary Viatorr ® TIPS. CONCLUSION Viatorr ® PS placement in the management of variceal hemorrhage is feasible with promising short term patency and clinical follow-up data.

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Section: Discussionmentioning

confidence: 99%

Parallel transjugular intrahepatic portosystemic shunt with Viatorr^® stents for transjugular intrahepatic portosystemic shunt insufficiency: A case report and review of literature

Raissi

Nisiewicz

et al. 2019

WJH

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“…Despite weak evidence, DU protocols have been transferred to ePTFE-covered stent-grafts in most centers [5,26] without changing parameters, thresholds, or surveillance intervals. Some small studies found a difference of flow parameters compared to bare stents [9,10,18,21]. Importantly, direct assessment of flow parameters inside the covered part of the TIPS is impossible during the first days due to artifacts caused by gas remnants inside the cover of the stent-graft [10,25].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it can be assumed that risk of TIPS dysfunction is highest during early follow-up [7,8]. While surveillance of TIPS patency with Doppler ultrasound (DU) and/or angiography was crucial in the era of bare metal stents [5,18,22,23], evidence regarding accuracy of DU [9,11,21,24,25] and necessity of long-term surveillance [7,8] in the Viatorr era is limited. Some authors and consensus conferences even state that there is no need for routine Doppler surveillance in asymptomatic patients anymore [9 -12, 19 -21], while others recommend scheduled Doppler surveillance every 6 months [5,18].…”

Section: Introductionmentioning

confidence: 99%

Doppler ultrasound surveillance of TIPS-patency in the era of covered stents – retrospective analysis of a large single-center cohort

et al. 2018

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Despite acceptable accuracy, scheduled DU surveillance proved to have minor therapeutic impact. Thus, detailed DU surveillance is not useful in asymptomatic patients after 2 years of unremarkable follow-up. In contrast, long-term DU surveilleance should be performed in patients after successful revision of TIPS dysfunction and patients with prothrombotic states (e. g., portal vein thrombosis, Budd-Chiari syndrome).

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“…The first endovascular stent used in the creation of a TIPS procedure was the balloon-expandable Palmaz stent (Cordis Corporation, Miami Lakes, FL, USA) [5]. Over the time, self-expandable Wallstent endoprothesis (Boston Scientific, Natick, MS, USA) became the preferred stent because of its flexibility, range of length and diameters, and ease of use [6, 7]. …”

Section: Introductionmentioning

confidence: 99%

Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experience

Buechter¹,

Manka²,

Gerken³

et al. 2018

Dig Dis

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Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in decompensated portal hypertension. TIPS revision due to thrombosis or stenosis increases morbidity and mortality. Our aim was to investigate patient- and procedure-associated risk factors for TIPS-revision. Patients and Methods: We retrospectively evaluated 189 patients who underwent the TIPS procedure. Only patients who required TIPS revision within 1 year (Group I, 34 patients) and patients who did not require re-intervention within the first year (Group II [control group], 54 patients) were included. Results: Out of 88 patients, the majority were male (69.3%) and mean age was 56 ± 11 years. Indications for TIPS were refractory ascites (68%), bleeding (24%), and Budd-Chiari syndrome (8%). The most frequent liver disease was alcohol-induced cirrhosis (60%). Forty-three patients (49%) received bare and 45 patients (51%) covered stents, thus resulting in reduction of hepatic venous pressure gradient (HVPG) from 19.0 to 9.0 mm Hg. When comparing patient- and procedure-related factors, the type of stent (p < 0.01) and interventionalist’s experience (number of performed TIPS implantations per year; p < 0.05) were the only factors affecting the risk of re-intervention due to stent dysfunction, while age, gender, indication, Child-Pugh, and model of end-stage liver disease score, platelet count, pre- and post-HVPG, additional variceal embolization, stent diameter, and number of stents did not significantly differ. Conclusion: Patients undergoing TIPS procedure should be surveilled closely for shunt dysfunction while covered stents and high-level experience are associated with increased patency.

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Post–Transjugular Intrahepatic Portosystemic Shunt Follow-Up and Management in the VIATORR Era

Cited by 22 publications

References 49 publications

Parallel transjugular intrahepatic portosystemic shunt with Viatorr^® stents for transjugular intrahepatic portosystemic shunt insufficiency: A case report and review of literature

Parallel transjugular intrahepatic portosystemic shunt with Viatorr^® stents for transjugular intrahepatic portosystemic shunt insufficiency: A case report and review of literature

Doppler ultrasound surveillance of TIPS-patency in the era of covered stents – retrospective analysis of a large single-center cohort

Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experience

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Post–Transjugular Intrahepatic Portosystemic Shunt Follow-Up and Management in the VIATORR Era

Cited by 22 publications

References 49 publications

Parallel transjugular intrahepatic portosystemic shunt with Viatorr® stents for transjugular intrahepatic portosystemic shunt insufficiency: A case report and review of literature

Parallel transjugular intrahepatic portosystemic shunt with Viatorr® stents for transjugular intrahepatic portosystemic shunt insufficiency: A case report and review of literature

Doppler ultrasound surveillance of TIPS-patency in the era of covered stents – retrospective analysis of a large single-center cohort

Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension: Patency Depends on Coverage and Interventionalist’s Experience

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Parallel transjugular intrahepatic portosystemic shunt with Viatorr^® stents for transjugular intrahepatic portosystemic shunt insufficiency: A case report and review of literature

Parallel transjugular intrahepatic portosystemic shunt with Viatorr^® stents for transjugular intrahepatic portosystemic shunt insufficiency: A case report and review of literature