Vizzutti F, Arena U, Rega L, Zipoli M, Abraldes J G, Romanelli R G, Tarquini R, Laffi G, Pinzani M
Department of Internal Medicine, University of Florence, Florence, Italy.
Gut. 2009 Apr;58(4):582-4. doi: 10.1136/gut.2008.172486.
The use of polytetrafluoroethylene (PTFE)-covered prostheses improves trans-jugular intrahepatic porto-systemic shunt (TIPS) patency and decreases the incidence of clinical relapses and re-interventions. Therefore, the improvement provided by covered stents might expand the currently accepted recommendations for TIPS use. Stent-related occlusion of the hepatic vein with consequent ischaemia of the corresponding liver parenchyma emerges as a novel complication reported in at least 5% of patients implanted with coated stents. However, this complication was reported to be mild, without signs or symptoms of liver failure, and self-limiting. We report a case of segmental liver ischaemia following PTFE-covered stent placement resulting in a marked impairment in liver function in a patient with hepatitis C virus cirrhosis implanted because of refractory oesophageal bleeding, thus expanding the severity range of this new procedural complication. Moreover, we discuss the possible involvement of additional pathogenetic mechanisms other than out-flow obstruction in the onset of coated-stent induced congestive liver ischaemia.
使用聚四氟乙烯（PTFE）覆膜假体可提高经颈静脉肝内门体分流术（TIPS）的通畅率，并降低临床复发和再次干预的发生率。因此，覆膜支架所带来的改善可能会扩大目前关于TIPS使用的公认建议。肝静脉支架相关闭塞以及相应肝实质的缺血是一种新出现的并发症，在至少5%的植入覆膜支架的患者中被报道。然而，据报道这种并发症较轻，没有肝功能衰竭的体征或症状，且具有自限性。我们报告一例因丙型肝炎病毒肝硬化导致难治性食管出血而植入PTFE覆膜支架后出现节段性肝缺血的病例，该病例导致肝功能严重受损，从而扩大了这种新手术并发症的严重程度范围。此外，我们讨论了在覆膜支架诱导的充血性肝缺血发病过程中，除流出道梗阻外其他可能的致病机制。
