Transjugular Intrahepatic Portosystemic Shunt Creation with the Viatorr Expanded Polytetrafluoroethylene–Covered Stent-Graft

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

“…The overall rebleeding rate following TIPS in this study was slightly higher than that reported in literature for Viatorr TIPS [10,23,24]. The reason for this is uncertain, as no noteworthy differences in patient demographics, liver disease characteristics or procedure technical factors were identified.…”

“…The e-PTFE covered Viatorr stent-graft, which was approved by the US Food and Drug Administration in 2004, improves shunt patency by minimizing transmural bile permeation and thereby reducing tissue ingrowth. TIPS primary patency with the Viatorr stentgraft has been found to range between 80 and 90% at 1 year [8,10,22,23] and the use of the Viatorr has shown further reduction in rates of recurrent hemorrhage following TIPS to \10% [10,23,24].…”

“…Underlying liver disease included alcoholic (n = 21), hepatitis B and/or hepatitis C virus (n = 9), alcoholic and hepatitis C virus (n = 6), non-alcoholic steatohepatitis (NASH) (n = 7), primary biliary cirrhosis (n = 5), autoimmune (n = 2), alpha-one antitrypsin deficiency (n = 1) and unknown (n = 1) causes of cirrhosis. Liver disease included Child-Pugh class A (n = 6), B (n = 28) and C (n = 18) disease (median Child-Pugh score = 8.5, 95% CI 7.0-9.4, range [5][6][7][8][9][10][11][12][13][14][15]. Median model for end-stage liver disease (MELD) score was 13.5 (95% CI 11.0-17.4, range 4-47).…”

“…Early TIPS were performed using bare metal stents, which were associated with high rates of shunt stenosis and dysfunction [6,7]. More recently, covered stent-grafts have been shown to improve TIPS patency [8][9][10][11], and the specialized expanded polytetrafluoroethylene (e-PTFE) covered Viatorr stent (W.L. Gore and Associates, Flagstaff AZ) is now widely used for TIPS creation.…”

Influência do grau de insuficiência hepática e do índice de congestão portal na recidiva hemorrágica de cirróticos submetidos a cirurgia de Teixeira-Warren

“…Inicialmente, quando os enxertos auto-expansíveis não eram revestidos, tinha-se alto índice de obstrução após 6 a 12 meses de uso, devendo ser trocados, implicando em aumento da morbimortalidade, principalmente por recidiva hemorrágica (1) . Hoje em dia, com a melhora tecnológica e o surgimento de enxertos revestidos por politetra-fluoroetileno, a patência do TIPS melhorou muito, variando de 80% a 84% em 1 ano e chegando a 75% no final de 2 anos, porém sem melhora na taxa de mortalidade, própria da cirrose (1,4,7,12,30,32) . Infelizmente, nem sempre esse tratamento está disponível em todos os serviços, principalmente no sistema público, devido ao seu elevado custo.…”