Clinical Application Of Viatorr Covered Stent In Transjugular Intrahepatic Portosystemic Shunt

Background and Objective:Transjugular intrahepatic portosystemic shunt(TIPS)is an interventional treatment technology by using stents in the liver parenchyma between the hepatic vein and portal vein to establish the distributary channel,in order to achieve shunt portal venous blood flow and reduce the portal vein pressure.This technique was first used in clinical in 1989 by Richter,which has been widely used in the treatment of portal hypertension,such as esophageal and gastric varices bleeding,refractory ascites,hepatic hydrothorax and Budd-Chiari syndrome,as well as prevention of fatal complications before liver transplantation,which achieved significant curative effect.However,restenosis or occlusion after TIPS has been the main factor affecting the long-term efficacy of TIPS.According to the statistics,rates of restenosis or occlusion after 1 year,2 years,5 years after TIPS were as high as 5?64%,33?70%,60?85%,respectively.Since Viatorr stent has been dedicated to TIPS from 2004,the rate of shunt pass increased significantly,while Viatorr coated stent is also the standard stent in the TIPS Guidance in Europe and the United States.In October 2015,Viatorr stent was in the domestic market,there were not so many clinical reports in the domestic.The aim of this study was to investigate the operative technique and initial efficacy of Viatorr covered stent in the treatment of portal hypertension with TIPS.Methods:In this study,10 patients with portal hypertension complicated with variceal bleeding and Viatorr coated stent were accepted in TIPS from October 2015 to March 2017.Direct portal venous pressure was examined in all patients before and after surgery,regular blood routine,liver function and blood coagulation function were performed regularly in postoperative 1,3,6,12 months;abdominal color Doppler ultrasound and enhanced CT in liver were performed to understand the stent patency.Angiography was performed in those patients with suspected shunt dysfunction,intervention for correction,if necessary.Re-bleeding,ascites regression and complications were observed during the follow-up.Results:1.10 cases were all operated successfully for once time,the success rate was 100%.2.The portal pressure was(30.80±4.83)mmHg and(18.20±3.46)mmHg before and after TIPS,respectively(1mmHg =0.133kPa,paired t test,t=10.89,P<0.001),the average decrease of portal pressure after the shunt was(41.17 ± 8.87)%than before.3.10 cases were followed up for 1?17 months(average for 218 days).During the follow-up,1 cases died of abdominal infection on the 148 day after surgery;1 cases had spontaneous bacterial peritonitis and septic shock on the 83 day after surgery,and improved after anti-infection therapy;1 case had ulcer bleeding induced by aspirin on the 23 day after surgery,melena disappeared after discontinuation of aspirin;the other 7 patients with a history of recurrent variceal hemorrhage showed released or disappeared varices in reexamined gastroscopy after postoperative follow-up for 1-3 months,there were no symptoms of hematemesis,melena occurred at the end of follow-up.4.TIPS shunt was all unobstructed in all patients until the end of the follow-up(or before the death),there were no symptom of hepatic encephalopathy.Conclusions:Viatorr stunt can maintain the shunt patency for the long time,reduce the rate of re-bleeding,as well as the low complication rate of hepatic encephalopathy,which provide a safe and effective treatment for intrahepatic portosystemic shunt in portal hypertension patients.