REPEAT ENDOVASCULAR INTERVENTIONS AFTER TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS) PROCEDURES

Shipovsky V.N., Tsitsiashvili M.Sh., Saakyan A.M., Monakhov D.V., Khuan Ch., Nechaev A.I.
Municipal Clinical Hospital №57 Paediatric Department, Chair of Surgical Diseases Russian State Medical University,
Moscow, Russia

The authors share their experience with transjugular intrahepatic portosystemic shunt (TIPS) procedures preformed in a total of fifty-nine patients diagnosed with and hence operated on for class B and C hepatocirrhosis (according to the Child-Turcotte-Pugh classification), portal hypertension, grade 3 varicosely dilated oesophageal veins, or ascites. Of these, there were 12 women and 47 men (average age 56.3 years). Three types of stents were used: matrix stents (PERICO), self-expanding (ZA-stents, OptiMed sinus-SuperFlex-Visual stents, Zilver stents, SMART), and coated self-expanding stents (Gore Viatorr TIPS Endoprosthesis). Six (11%) TIPS procedures ended in failure. Of the remaining 53 successful TIPS attempts, thirteen patients developed an in-stent thrombosis at various terms postoperatively, with one patient having experienced it twice Within four postoperative days, thrombosis occurred in three patients, at terms varying from one month to three months in five patients, and from 6 to 12 months in a further five patients. More often thromboses were encountered with the matrix stents (n = 3) 23.0% (PERICO) and self-expanding stents (n = 8) in 61.0% (OptiMed sinus-SuperFlex-Visual).

Thromboses were clinically manifested by oesophageal variceal haemorrhage. An in-stent thrombosis was confirmed by means of ultrasonographic duplex scanning (lack of arterial blood flow). The primary stent patency rate following TIPS procedures amounted to 67%. with the secondary assisted graft patency rate equalling 89%. Restoration of the stent’s lumen after TIPS procedures by means of endovascular recanalization, rheolytic thrombectomy, balloon angioplasty, and a stent-in-stent technique appears to be a minimally invasive, rather efficient method and virtually the only way to preserve the stent’s patency. This technique makes it possible to decrease the rate of recurrent oesophageal variceal haemorrhage.

KEY WORDS: hepatocirrhosis, portal hypertension syndrome, varicosely dilated oesophageal veins, transjugular intrahepatic portosystemic shunt (TIPS), rheolytic thrombectomy, balloon angioplasty.

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