Recurrent TIPS failure associated with biliary fistulae: Treatment with PTFE-covered stents |
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Authors: | Daniel Y Sze Thomas Vestring Robert P Liddell Noriyuki Kato Charles P Semba Mahmood K Razavi Stephen T Kee Michael D Dake |
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Institution: | (1) Division of Cardiovascular and Interventional Radiology, Stanford University Medical Center, Stanford, CA 94305-1056, USA, US;(2) Institut fuer Klinische Radiologie, Universitaetsklinik Muenster, Albert-Schweitzer-Strasse 33, D-48149 Muenster, Germany, DE;(3) Department of Radiology, Mie University School of Medicine, 2185 Fujikata, Tsu, Mie 514, Japan, JP |
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Abstract: | Purpose: To evaluate the efficacy of covered stents for the treatment of transjugular intrahepatic portosystemic shunt (TIPS) obstruction
in human subjects with identified or suspected biliary fistulae.
Methods: Five patients were treated for early failure of TIPS revisions. All had mid-shunt thrombus, and four of these had demonstrable
biliary fistulae. Three patients also propagated thrombus into the native portal venous system and required thrombolysis.
TIPS were revised in four patients using a custom-made polytetrafluoroethylene (PTFE)-covered Wallstent, and in one patient
using a custom-made PTFE-covered Gianturco Z-stent.
Results: All identified biliary fistulae were successfully sealed. All five patients maintained patency and function of the TIPS during
follow-up ranging from 2 days to 21 months (mean 8.4 months). No patient has required additional revision. Thrombosis of the
native portal venous system was treated with partial success by mechanical thrombolysis.
Conclusion: Early and recurrent failure of TIPS with mid-shunt thrombosis, which may be associated with biliary fistulae, can be successfully
treated using covered stents. Stent-graft revision appears to be safe, effective, and potentially durable. |
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Keywords: | : Stents and prostheses— Portosystemic shunt transjugular intrahepatic— Biliary fistula— Hypertension portal— Portal vein thrombosis— Thrombolysis |
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