Spiliopoulos Stavros, Vasiniotis Kamarinos Nikiforos, Konstantos Chrysostomos, Palialexis Konstantinos, Reppas Lazaros, Tsitskari Maria, Brountzos Elias
2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece.
Cardiovasc Intervent Radiol. 2018 May;41(5):799-803. doi: 10.1007/s00270-018-1887-2. Epub 2018 Jan 29.
To report the safety and efficacy of occluded transjugular intrahepatic portosystemic shunts (TIPS) recanalization using the stiffening cannula (SC) technique.
This is a retrospective, single-centre, single-arm study, investigating the safety and efficacy of transjugular recanalization of occluded TIPS using the SC (Cook, Ind. USA), in cases of failure to cross the occlusion with standard angiographic catheters and balloons. Between October 2015 and October 2017, a total of 15 TIPS revisions have been performed due to shunt occlusion. In all cases in which the initial standard approach to cross the lesion failed, the SC technique was used. The study's primary efficacy outcome measure was technical success, and primary safety outcome measure was immediate procedure-related complications rate. Secondary outcome measures included restenosis and peri-procedural adverse events rates.
Among 15 patients with shunt occlusion, seven (7/15; 46.5%) were successfully crossed via transjugular access, using standard angiographic catheters. In the remaining eight patients (nine procedures), recanalization with the SC technique was performed. Technical success was 100%. No complications or peri-procedural adverse events were noted. Restenosis rate was 11.1% (1/9 cases) as only one case of re-occlusion was noted, 3 months following recanalization using sole balloon angioplasty and successfully retreated using the SC technique and stent graft deployment.
The SC technique is a safe and efficient option for the recanalization of occluded TIPS, in cases in which conventional lesion crossing is not feasible, in order to avoid percutaneous transhepatic access or new TIPS creation.
报告使用强化套管（SC）技术进行闭塞性经颈静脉肝内门体分流术（TIPS）再通的安全性和有效性。
这是一项回顾性、单中心、单臂研究，旨在探讨在使用标准血管造影导管和球囊无法穿过闭塞部位的情况下，使用SC（美国印第安纳州库克公司）对闭塞性TIPS进行经颈静脉再通的安全性和有效性。2015年10月至2017年10月期间，共有15例因分流道闭塞而进行的TIPS翻修手术。在所有最初的标准方法穿过病变失败的病例中，均采用了SC技术。该研究的主要疗效指标是技术成功率，主要安全性指标是即时手术相关并发症发生率。次要指标包括再狭窄率和围手术期不良事件发生率。
在15例分流道闭塞患者中，7例（7/15；46.5%）使用标准血管造影导管经颈静脉成功穿过闭塞部位。其余8例患者（9次手术）采用SC技术进行再通。技术成功率为100%。未观察到并发症或围手术期不良事件。再狭窄率为11.1%（1/9例），仅1例再闭塞病例，在单纯球囊血管成形术再通3个月后被发现，随后使用SC技术和覆膜支架置入成功治疗。
对于传统病变穿过不可行的闭塞性TIPS再通，SC技术是一种安全有效的选择，可避免经皮肝穿刺途径或创建新的TIPS。
