Radiology, Vol 191, 173-176, Copyright © 1994 by Radiological Society of North America
Overdilation of the Wallstent to optimize portal decompression during transjugular intrahepatic portosystemic shunt placement
K Valji, JJ Bookstein, AC Roberts, SB Oglevie, AP Royster and RR Varney
Department of Radiology, University of California, San Diego.
PURPOSE: To optimize shunt size with overdilation of the Wallstent during
creation of a transjugular intrahepatic portosystemic shunt (TIPS).
MATERIALS AND METHODS: A TIPS was created in 25 patients with variceal
bleeding (n = 22) or intractable ascites (n = 3). All shunts were created
with one or more Wallstents that were dilated with an 8- or 10-mm balloon.
In 11 patients with inadequate portal decompression or persistent filling
of varices, shunts were overdilated with a 12-mm balloon. RESULTS: Mean
portosystemic pressure gradient fell from 18.0 mm Hg +/- 6.4 (standard
deviation) to 6.8 mm Hg +/- 2.8 after shunt placement. In 11 patients in
which shunts were overdilated, the mean gradient fell from 12.7 mm Hg +/-
5.6 after 10-mm dilation to 6.9 mm Hg +/- 2.8 (P = .01) after 12-mm
dilation. In six, variceal filling occurred after 10-mm dilation but
diminished or ceased after overdilation. Stent disruption did not occur.
New or worsened encephalopathy occurred in four of 14 patients with 10-mm
and six of 11 patients with 12-mm shunt dilation and responded to medical
therapy in all but two. CONCLUSION: Overdilation of the Wallstent during
TIPS placement is effective and safe in patients with inadequate portal
decompression after 10-mm shunt dilation.
