Radiology, Vol 196, 341-347, Copyright © 1995 by Radiological Society of North America
Improved transjugular intrahepatic portosystemic shunt patency with PTFE-covered stent-grafts: experimental results in swine
K Nishimine, RR Saxon, K Kichikawa, J Mendel-Hartvig, HA Timmermans, HJ Shim, BT Uchida, RE Barton, FS Keller and J Rosch
Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201-3098, USA.
PURPOSE: To evaluate the ability of stent-grafts made with
polytetrafluoroethylene (PTFE) graft material to improve transjugular
intrahepatic portosystemic shunt (TIPS) patency. MATERIALS AND METHODS:
TIPS were created in 13 swine by using PTFE-covered stent-grafts. Uncovered
TIPS were placed in 13 other swine. Twenty-one of 26 animals were followed
up with portal venography for 3 months or until the shunt became severely
stenotic. Five animals without severe stenosis were sacrificed before 3
months because of illness. RESULTS: At 4 weeks after TIPS placement, nine
of 13 stent-graft TIPS were patent (< 50% diameter narrowing) compared
with only one patent stent in 13 uncovered TIPS. Six of 13 stent-graft TIPS
remained patent until the animals were sacrificed. In 11 of 12 uncovered
TIPS, stenosis was most prominent in the parenchymal tract. In five of
seven stent-graft TIPS, stenosis was most prominent in the hepatic vein
above the end of the graft material. Bile leaks were discovered in six
occluded uncovered TIPS and in two of the stent-graft TIPS. CONCLUSION:
PTFE-covered stent-grafts significantly improved TIPS patency in swine (P
< .01). However, stenosis in the hepatic vein led to late shunt
malfunction in selected cases.
