Erik Maki MD, Presenter: Nothing to Disclose

Ryan Carl Schenning MD, Abstract Co-Author: Nothing to Disclose

Daniel Horner, Abstract Co-Author: Nothing to Disclose

Khashayar Farsad MD, PhD, Abstract Co-Author: Nothing to Disclose

A clinically significant complication of a transjugular intrahepatic portosystemic shunt (TIPS) is hepatic encephalopathy (HE), which in medically refractory cases requires secondary constraining techniques. We examined the safety and feasibility of creating a primarily constrained TIPS which can then be dilated as needed to create a larger shunt.

50 cases of primarily constrained elective TIPS at a single institution were retrospectively reviewed. The primary indication for TIPS creation was medically-refractory ascites or recurrent variceal bleeding. After transjugular portal venous access was achieved, a balloon-expandable stent was deployed in the parenchymal tract as an external contstraining device. A Gore-Viatorr stent graft was then deployed within the constraining stent, and the stents were balloon dilated to achieve the desired portosystemic gradient. Retrospective chart review was performed to assess safety and feasibility of the procedure.

Technical success was 100%. Symptom resolution occurred in 43(86%) of patients during a mean follow up period of 9.3 months. 13(26%) of patients underwent revision of their constrained TIPS. Of these, 10(77%) had only dilation of the constraining stent for symptom recurrence and 1(8%) required only restriction for HE. 2(15%) underwent initial dilation for symptom recurrence but then needed restriction for HE. One patient ultimately required shunt occlusion for HE. Stent thrombosis occurred in 4(8%) of patients. There was one post-procedure complication from transfusion of blood products.

Primarily constrained TIPS creation is safe and feasible. This technique improves control of the portosystemic gradient reduction at the time of TIPS creation, and enables a small shunt to be created in select individuals, with the easy ability to subsequently increase the shunt as needed with balloon dilation.

Primary placement of a constrained TIPS is a safe and feasible procedure, which improves control of the portosystemic gradient at the time of TIPS placement and during follow-up.

Maki, E, Schenning, R, Horner, D, Farsad, K, Safety and Feasibility of Primary Placement of a Constrained Transjugular Intrahepatic Portosystemic Shunt (TIPS).  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015118.html