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  • Title: Overdilation of the Wallstent to optimize portal decompression during transjugular intrahepatic portosystemic shunt placement.
    Author: Valji K, Bookstein JJ, Roberts AC, Oglevie SB, Royster AP, Varney RR.
    Journal: Radiology; 1994 Apr; 191(1):173-6. PubMed ID: 8134565.
    Abstract:
    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.
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