Recurrent TIPS failure associated with biliary fistulae: Treatment with PTFE-covered stents

Daniel Y. Sze, Thomas Vestring, Robert P. Liddell, Noriyuki Kato, Charles P. Semba, Mahmood K. Razavi, Stephen T. Kee, Michael D. Dake

Research output: Contribution to journalArticlepeer-review

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 midshunt 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.

Original languageEnglish (US)
Pages (from-to)298-304
Number of pages7
JournalCardiovascular and interventional radiology
Volume22
Issue number4
DOIs
StatePublished - Jul 1 1999
Externally publishedYes

Keywords

  • Biliary fistula
  • Hypertension, portal
  • Portal vein, thrombosis
  • Portosystemic shunt, transjugular intrahepatic
  • Stents and prostheses
  • Thrombolysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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