Haskal Z J
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, USA.
Radiology. 1999 Dec;213(3):759-66. doi: 10.1148/radiology.213.3.r99dc28759.
To determine whether polytetrafluoroethylene (PTFE) stent-grafts yield longer patency for creation or revision of transjugular intrahepatic portosystemic shunts (TIPS).
Fourteen PTFE-covered Wallstents were placed in 13 patients with TIPS: seven at shunt creation and seven during revision of TIPS with one to five prior thromboses at 1 day to 1 year after initial TIPS formation. In six cases, prior to stent-graft placement persistent biliary-TIPS fistulas were demonstrated despite repeated shunt revisions with additional metallic stents.
All but one graft-lined TIPS were widely patent at a mean duration of venographic follow-up of 19 months (median, 17 months; range, 5-32 months). The limiting percentage of stenosis within the grafted shunts was 0%-10%. One patient developed stent-graft thrombosis; the prior biliary-TIPS fistula was seen despite the graft. A second, parallel PTFE-lined transcaval shunt was created in this patient; it was widely patent at 11-month follow-up. In two asymptomatic patients, stenoses developed in the short, nongrafted portions of the outflow hepatic veins.
PTFE stent-grafts can markedly prolong TIPS patency, potentially reducing the need for shunt follow-up and revision and the risk of recurrent symptoms associated with shunt stenosis or occlusion.
确定聚四氟乙烯（PTFE）覆膜支架移植物用于经颈静脉肝内门体分流术（TIPS）的建立或修复时，是否能使分流道保持更长时间的通畅。
将14个PTFE覆膜Wallstent支架植入13例TIPS患者体内：7例用于建立分流道，7例用于TIPS修复，这些患者在初次TIPS形成后1天至1年曾发生1至5次血栓形成。6例患者在植入支架移植物前，尽管多次使用额外的金属支架对分流道进行修复，但仍存在持续性胆-门体分流瘘。
除1例有支架内衬的TIPS外，其余所有TIPS在平均19个月（中位数，17个月；范围，5 - 32个月）的静脉造影随访期间均广泛通畅。植入分流道内的狭窄限制百分比为0% - 10%。1例患者发生支架移植物血栓形成；尽管有支架移植物，但仍可见先前的胆-门体分流瘘。在该患者体内建立了第二个平行的PTFE内衬经腔静脉分流道；在11个月的随访中，该分流道广泛通畅。2例无症状患者的肝静脉流出道短的非植入部分出现狭窄。
PTFE支架移植物可显著延长TIPS的通畅时间，可能减少对分流道进行随访和修复的需求，以及与分流道狭窄或闭塞相关的复发症状风险。
