[Technological modification of transjugular intrahepatic portosystemic shunt: the precise covering of parenchymal shunt with stent-graft].

OBJECTIVE: To introduce the technological modification of stents placement with combined naked self-expanding stent and stent-graft for the construction of portosystemic shunt during transjugular intrahepatic portosystemic shunt (TIPS).

METHODS: In the study, 17 patients who suffered from upper digestive tract hemorrhage due to portal hypertension post liver cirrhosis underwent modified TIPS. The shunts were constructed with stepwise placement of naked self-expanding stent and a stent-graft other than stent-graft only for the purpose of precisely covering the parenchymal segment of the shunt and the active control of portosystemic gradient (PSG). The feasibility, safety, and clinical application results of the new technique were analyzed.

RESULTS: Technically, the success rate of operation was 100%. The mean PSG before and after TIPS was (28.2 ± 7.6) mmHg, (12.1 ± 3.5) mmHg, respectively (1 mmHg = 0.133 kPa, P < 0.001). One patient died 6 days after operation. The median follow-up period was 181 days (ranging from 32 days to 563 days) for all the other 16 cases, during which period 3 patients died because of encephalopathy, liver failure and septicemia, respectively, and 2 cases of encephalopathy occurred and were relieved with medical treatment. The shunts patency rate was 100% and no chance of digestive re-bleeding occurred. The mean Child-Pugh score before TIPS and at the end of the follow-up was (7.8 ± 2.0) points and (7.5 ± 1.7) points, respectively (P = 0.584).

CONCLUSION: The technological modification of TIPS with combined naked self-expanding stent and stent-graft for the precise covering of the parenchymal segment of the shunts was relatively simple to apply, and was helpful for the adjustment of PSG. The preliminary clinical application indicated that it had satisfying results in the matter of shunts patency, incidence of encephalopathy, and the relapse of digestive bleeding during the short-term follow-up.