Raissi Driss, Yu Qian, Nisiewicz Michael, Krohmer Steven
Department of Radiology, University of Kentucky, Lexington, KY 40536, United States.
World J Hepatol. 2019 Feb 27;11(2):217-225. doi: 10.4254/wjh.v11.i2.217.
Transjugular intrahepatic portosystemic shunts (TIPS) can alleviate complications of portal hypertension such as ascites and variceal bleeding by decreasing the portosystemic gradient. In limited clinical situations, parallel TIPS may be only solution to alleviate either variceal bleeding or ascites secondary to portal hypertension when the primary TIPS fails to do so. Data specifically addressing the use of this partially polytetrafluoroethylene covered nitinol stent (Viatorr) is largely lacking despite Viatorr being the current gold standard for modern TIPS placement.
All three patients had portal hypertension and already had a primary Viatorr TIPS placed previously. All patients have undergone failed endoscopy to manage acute variceal bleeding before referral for a parallel stent (PS). PS were placed in patients presenting with recurrent variceal bleeding despite existence of a widely patent primary TIPS. Primary stent patency was verified with either Doppler ultrasound or intra-procedural TIPS stent venography. Doppler ultrasound follow-up imaging demonstrated complete patency of both primary and parallel TIPS. All three patients did well on clinical follow-up of up to six months and no major complications were recorded. A review of existing literature on the role of PS in the management of portal hypertension complications is discussed. There are three case reports of use of primary and PS Viatorr stents placement, only one of which is in a patient with gastrointestinal variceal bleeding despite a patent primary Viatorr TIPS.
Viatorr PS placement in the management of variceal hemorrhage is feasible with promising short term patency and clinical follow-up data.
经颈静脉肝内门体分流术（TIPS）可通过降低门体压力梯度来缓解门静脉高压的并发症，如腹水和静脉曲张出血。在有限的临床情况下，当原发性TIPS无法缓解门静脉高压继发的静脉曲张出血或腹水时，并行TIPS可能是唯一的解决办法。尽管Viatorr是现代TIPS置入的当前金标准，但专门针对这种部分聚四氟乙烯覆膜镍钛诺支架（Viatorr）使用的数据却非常缺乏。
所有三名患者均患有门静脉高压，此前已置入原发性Viatorr TIPS。所有患者在转诊接受并行支架（PS）治疗前，内镜治疗急性静脉曲张出血均失败。尽管原发性TIPS广泛通畅，但仍有复发性静脉曲张出血的患者接受了PS置入。通过多普勒超声或术中TIPS支架静脉造影证实原发性支架通畅。多普勒超声随访成像显示原发性和并行TIPS均完全通畅。所有三名患者在长达六个月的临床随访中情况良好，未记录到重大并发症。本文讨论了现有文献中关于PS在门静脉高压并发症管理中的作用。有三篇关于原发性和PS Viatorr支架置入的病例报告，其中只有一篇是关于尽管原发性Viatorr TIPS通畅但仍有胃肠道静脉曲张出血的患者。
Viatorr PS置入术用于治疗静脉曲张出血是可行的，短期通畅性和临床随访数据前景良好。
