PTFE-encapsulated endovascular stent-graft for transjugular intrahepatic portosystemic shunts: experimental evaluation.

Haskal, Ziv J.; Davis, Andrew G.; McAllister, A.James; Furth, Emma E.

doi:10.1148/radiology.205.3.9393521

Cited by 101 publications

(48 citation statements)

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“…In addition, they emphasize the feasibility and efficacy of PTFE-covered stents used not only for de novo indications but also for the correction of TIPS dysfunction in patients with severe clinical recurrence. 26,30,32 Importantly, it should be noted that no Budd-Chiari patient in this series who was treated with a PTFE-covered stent developed liver infarcts. Liver infarcts have been reported after PTFE stents in patients with liver cirrhosis and are due, in most cases, to the obstruction of the hepatic vein by the covered stent.…”

Section: Discussionmentioning

confidence: 75%

PTFE-covered stents improve TIPS patency in Budd-Chiari syndrome

et al. 2004

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Transjugular intrahepatic portosystemic shunt (TIPS) have been shown to be an efficient portal-systemic derivative treatment for Budd-Chiari syndrome (BCS) patients uncontrolled by medical therapy. However, the main drawback of TIPS for this condition is a very high rate of shunt dysfunction. Recently, polytetrafluoroethylene (PTFE)-covered stents have been shown to reduce the incidence of TIPS dysfunction in patients with cirrhosis. The aim of the study was to assess the incidence of TIPS dysfunction in 2 cohorts of BCS patients treated with bare or PTFE-covered stents. The study included 25 TIPS procedures (16 bare stents and 9 covered stents) with a median follow-up period of 20.4 months (range, 3.9-124.8). Fourteen of 16 patients (87%) receiving bare stents had TIPS dysfunction compared to 3 of the 9 patients (33%) receiving PTFE-covered stents (P ‫؍‬ .005). The actuarial rates of primary patency in the bare-stent group were 19% at 1 year compared with 67% in the PTFE-covered stent group (P ‫؍‬ .02; log-rank test). The number of additional interventional procedures to maintain TIPS patency was significantly greater in the bare-stent than in the PTFE-covered stent group (1.9 ؎ 1.2 vs. 0.6 ؎ 0.9; P ‫؍‬ .007). The number of patients with clinical relapses was greater in the bare-stent group compared to the PTFE-covered stent group (13 vs. 5 episodes in 9 and 3 patients, respectively). In conclusion, PTFE-covered stents have a considerable advantage over bare stents for the TIPS treatment of BCS patients, with a lower dysfunction rate, a lower number of reinterventions, and fewer prosthesis requirements. PTFE-covered stents are preferable in patients with Budd-Chiari Syndrome.

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Section: Discussionmentioning

confidence: 75%

PTFE-covered stents improve TIPS patency in Budd-Chiari syndrome

et al. 2004

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“…Accordingly, understanding the predisposing factors leading to TIPS dysfunction and efforts to solve those problems are necessary to maintain long-term patency after TIPS placement. Currently, the best solution for TIPS dysfunction seems to be the use of polytetrafluoroethylene-covered stent grafts that isolate blood from hepatic tissue, therefore blocking the tentative triggering mechanisms of pseudointimal and intimal hyperplasia or thrombosis (19)(20)(21)(22)(23)(24)(25)(26)(27). Recently, a meta-analysis of six studies demonstrated not only a significant improvement of primary patency (hazard ratio [HR], 0.28) and a significant reduction of risk of hepatic encephalopathy (HR, 0.65), but also a significant decrease of mortality in the covered-stent group (HR, 0.76) (25).…”

Section: Discussionmentioning

confidence: 99%

“…Among many theories, widely accepted ones are thrombosis, pseudointimal hyperplasia caused by bile leaks of transected bile ducts into the stent lumen, and intimal hyperplasia of the hepatic vein outflow tract (16)(17)(18). Recently, use of polytetrafluoroethylene (PTFE)-covered stents has decreased TIPS dysfunction by allowing endoluminal endothelial lining and preventing bile leak into the stent (19)(20)(21)(22)(23)(24)(25)(26)(27).…”

Section: Introductionmentioning

confidence: 99%

Stent Dysfunction After Transjugular Intrahepatic Portosystemic Shunt: A 14-Year Experience from a Single Tertiary Medical Center

Kim

Gwon

et al. 2017

Iran J Radiol

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Background: The predisposing factors leading to transjugular intrahepatic portosystemic shunt (TIPS) dysfunction, other than the use of bare stents, which are often the only available options, have not been elucidated well to date. Objectives: To analyze clinical outcomes after TIPS created with bare stents and to assess risk factors for stent dysfunction. Patients and Methods: A total of 102 patients undergoing TIPS between January 1999 and December 2012 were retrospectively assessed. The incidence of stent dysfunction was evaluated, and associated risk factors were analyzed. Results: Symptom recurrence was observed in 51 (50%) patients, and TIPS revision was required in 37 (36%) during the mean followup period of 1889 days. The median stent patency and survival times were 470 and 1783 days, respectively. The only independent risk factor for stent dysfunction was portal trunk (right, left, or main portal trunk) access (P = 0.006). The median stent patency with segmental branch access (538 days) was significantly longer than that with portal trunk access (245 days) (P = 0.007). There were no significant differences in patient survival (P = 0.648), worsening of encephalopathy (P = .0742), or major complications (P = 1.000). Conclusion: TIPS created with segmental portal venous access has superior patency over that of TIPS with portal trunk access. However, we found no significant difference in patient survival, worsening of encephalopathy, or major complications between segmental access and portal trunk access.

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“…The stentgraft has also been used to treat hemorrhage after extrahepatic portal vein puncture during a TIPS procedure [16]. Several graft materials have been used for construction of stent-grafts [8][9][10]. The Viatorr stent-graft (W L Gore, Flagstaff, AZ, USA) used in our study is a nitinol-polytetrafluoroethylene stent-graft for TIPS, commercially available and easy to handle [17].…”

Section: Discussionmentioning

confidence: 99%

“…To overcome these problems, stent-grafts have been used [7][8][9][10][11][12]. These stent-grafts separate the shunt channel from the liver tissue, bile ducts, and the wall of the hepatic vein, preventing development of hyperplasia.…”

Section: Introductionmentioning

confidence: 99%

Acute Effects of Liver Vein Occlusion by Stent-Graft Placed in Transjugular Intrahepatic Portosystemic Shunt Channel: An Experimental Study

Keussen¹,

Bergqvist²,

Rissler³

et al. 2005

Cardiovasc Intervent Radiol

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The purpose of this study was to evaluate the effects of hepatic vein occlusion by stent-graft used in transjugular intrahepatic portosystemic shunt (TIPS). The experiments were performed in six healthy pigs under general anesthesia. Following percutaneous transhepatic implantation of a porta-cath in the right hepatic vein, TIPS was created with a stent-graft (Viatorr; W L Gore, Flagstaff, AZ, USA). The outflow from the hepatic vein, blocked by the stent-graft was documented by injection of contrast medium and repeated injections of 99 Tc m -labeled human serum albumin through the port-a-cath. After 2 weeks, the outflow was reevaluated, the pigs were sacrificed, and histopathologic examination of the liver was performed. Occlusion of the hepatic vein by a stent-graft had a short and temporary effect on the outflow. Histopathological examination from the affected liver segment showed no divergent pattern. Stentgrafts used in TIPS block the outflow from the liver vein, but do not have a prolonged circulatory effect and do not affect the liver parenchyma.Key words: Portal hypertension-Transjugular intrahepatic portosystemic shunt-Stent-graft-Hepatic vein occlusion Over the last 10 years, transjugular intrahepatic portosystematic shunt (TIPS) procedures have almost completely replaced surgical portosystemic shunts in treatment of patients with portal hypertension and repeated bleeding from gastroesophageal varices [1][2][3][4][5] or refractory ascites. Longterm results of TIPS are, however, unsatisfactory due to the development of pseudointimal hyperplasia in the shunt channel and/or intimal hyperplasia in the adjacent hepatic vein [6].To overcome these problems, stent-grafts have been used [7][8][9][10][11][12]. These stent-grafts separate the shunt channel from the liver tissue, bile ducts, and the wall of the hepatic vein, preventing development of hyperplasia.Following TIPS, blood from the portal vein passes through the created shunt toward the right atrium, whereas flow to the intrahepatic portal vein branches is substantially decreased [13]. The cranial portion used for the TIPS stentgraft might block the outflow from the hepatic vein to which the shunt extends. A decrease in the hepatic arterial flow to the liver segment drained by the blocked liver vein was reported [14] as well as segmental liver ischemia [15]. Patients treated with a TIPS often have an impaired liver function. Reduced blood flow through one liver segment can cause further deterioration.The present study was performed in order to evaluate if the outflow from the hepatic vein blocked by a stent-graft, causing a ''pseudo-Budd-Chiari-syndrome,'' changed over 2 weeks of time and if there were any possible consequences for the affected liver segment. Materials and Methods Animals and AnesthesiaSix healthy pigs, 36-40 kg body weight, were used for the experiments after approval from the local ethics committee for animal research. All procedures were performed under general anesthesia, induced by intramuscular injection of 2 mg/kg azapCorr...

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PTFE-encapsulated endovascular stent-graft for transjugular intrahepatic portosystemic shunts: experimental evaluation.

Abstract: This PTFE-encapsulated stent-graft is biocompatible and safe to place. It markedly improves TIPS patency, providing almost uninterrupted, unimpeded patency in this model.

Cited by 101 publications

References 0 publications

PTFE-covered stents improve TIPS patency in Budd-Chiari syndrome

PTFE-covered stents improve TIPS patency in Budd-Chiari syndrome

Stent Dysfunction After Transjugular Intrahepatic Portosystemic Shunt: A 14-Year Experience from a Single Tertiary Medical Center

Acute Effects of Liver Vein Occlusion by Stent-Graft Placed in Transjugular Intrahepatic Portosystemic Shunt Channel: An Experimental Study

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