Overdilation of the Wallstent to optimize portal decompression during transjugular intrahepatic portosystemic shunt placement.

PURPOSE

To optimize shunt size with overdilation of the Wallstent during creation of a transjugular intrahepatic portosystemic shunt (TIPS).

MATERIALS AND METHODS

A TIPS was created in 25 patients with variceal bleeding (n = 22) or intractable ascites (n = 3). All shunts were created with one or more Wallstents that were dilated with an 8- or 10-mm balloon. In 11 patients with inadequate portal decompression or persistent filling of varices, shunts were overdilated with a 12-mm balloon.

RESULTS

Mean portosystemic pressure gradient fell from 18.0 mm Hg +/- 6.4 (standard deviation) to 6.8 mm Hg +/- 2.8 after shunt placement. In 11 patients in which shunts were overdilated, the mean gradient fell from 12.7 mm Hg +/- 5.6 after 10-mm dilation to 6.9 mm Hg +/- 2.8 (P = .01) after 12-mm dilation. In six, variceal filling occurred after 10-mm dilation but diminished or ceased after overdilation. Stent disruption did not occur. New or worsened encephalopathy occurred in four of 14 patients with 10-mm and six of 11 patients with 12-mm shunt dilation and responded to medical therapy in all but two.

CONCLUSION

Overdilation of the Wallstent during TIPS placement is effective and safe in patients with inadequate portal decompression after 10-mm shunt dilation.