Use of balloon-expandable stents in transjugular intrahepatic portosystemic shunts in cases of Wallstent endoprosthesis technical failure and revision of shunt stenosis.

Thirteen patients underwent placement of a balloon-expandable stent either at initial transjugular intrahepatic portosystemic shunt (TIPS) creation (n = 3) because of immediate technical failure of the Wallstent or at shunt revision because of failure of the Wallstent to reduce the portosystemic gradient <or=12 mm Hg despite overdilation (n = 2), stenosis of the Wallstent (n = 1), or parenchymal tract shunt stenosis (n = 7). The mean duration of primary patency when balloon-expandable stents were used at initial shunt creation was 162.7 days +/- 110.1 (SD). The time from initial TIPS creation or shunt revision with a Wallstent to placement of a balloon-expandable stent was 88.6 days +/- 115.3. The time from balloon-expandable stent placement to shunt revision (n = 6), most recent follow-up (n = 2), death (n = 1), or liver transplantation (n = 1) was 171.9 days +/- 121.6. No significant difference in shunt patency was found between the Wallstent and balloon-expandable stent (P =.31). Because no added benefit in patency was seen between the balloon-expandable stent and Wallstent, it appears that balloon-expandable stent placement is valuable only when placement of a Wallstent technically fails as a result of its limited radial force or when precision in placement is needed to treat a hepatic vein stenosis near the confluence with the inferior vena cava.