Claus Christian Pieper1, Christian Jansen2, Carsten Meyer1, Jennifer Nadal3, Jennifer Lehmann2, Hans Heinz Schild1, Jonel Trebicka2, Daniel Thomas4. 1. Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, Bonn 53105, Germany. 2. Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Strasse 25, Bonn 53105, Germany. 3. Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Sigmund-Freud-Strasse 25, Bonn 53105, Germany. 4. Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, Bonn 53105, Germany. Electronic address: daniel.thomas@ukb.uni-bonn.de.
Abstract
PURPOSE: To prospectively investigate early expansion kinetics of underdilated self-expanding stent grafts used for transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS: Twenty patients (7 female; mean age 66 y; range, 31-80 y) with liver cirrhosis undergoing TIPS creation for variceal bleeding (n = 5), refractory ascites (n = 14), or both (n = 1) with underdilation of 10-mm stent grafts received two-dimensional (2-D) and three-dimensional (3-D) ultrasound (US) examinations immediately after TIPS creation and 1 and 6 weeks later. Orthogonal views of the TIPS within the parenchymal tract were reconstructed from 3-D volume data sets acquired in longitudinal orientation of the stent. 2-D images and reconstructed 3-D images were used for blinded diameter measurements. Measurement technique was validated with intrainterventional plain radiographs with a sizing catheter as the gold standard. Diameter changes over time and interrelations with patient characteristics (null hypothesis: no expansion, no interrelation) were analyzed using a general linear model for repeated measures. RESULTS: After dilation to 8-mm diameter, 2-D and 3-D measurements showed stent recoil (mean diameter 7.7 mm ± 0.21 and 7.6 mm ± 0.17, respectively). Diameter increased significantly from initial measurements to measurements at 1 and 6 weeks (2-D, 8.8 mm ± 0.24 and 9.4 mm ± 0.15, both P < .001; 3-D, 8.7 mm ± 0.27 and 9.4 mm ± 0.11, both P < .001). Validation measurements showed no significant differences between 2-D or 3-D US and gold standard. There were no statistically significant associations between stent expansion and clinical parameters (sex, P = .78; age, P = .82; etiology/grade of cirrhosis, P = .99; indication for TIPS, P = .78, liver stiffness, P = .70). CONCLUSIONS: Underdilated self-expanding stent grafts used for TIPS creation significantly expand within first 6 weeks after intervention. These changes can be noninvasively monitored using 3-D US.
PURPOSE: To prospectively investigate early expansion kinetics of underdilated self-expanding stent grafts used for transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS: Twenty patients (7 female; mean age 66 y; range, 31-80 y) with liver cirrhosis undergoing TIPS creation for variceal bleeding (n = 5), refractory ascites (n = 14), or both (n = 1) with underdilation of 10-mm stent grafts received two-dimensional (2-D) and three-dimensional (3-D) ultrasound (US) examinations immediately after TIPS creation and 1 and 6 weeks later. Orthogonal views of the TIPS within the parenchymal tract were reconstructed from 3-D volume data sets acquired in longitudinal orientation of the stent. 2-D images and reconstructed 3-D images were used for blinded diameter measurements. Measurement technique was validated with intrainterventional plain radiographs with a sizing catheter as the gold standard. Diameter changes over time and interrelations with patient characteristics (null hypothesis: no expansion, no interrelation) were analyzed using a general linear model for repeated measures. RESULTS: After dilation to 8-mm diameter, 2-D and 3-D measurements showed stent recoil (mean diameter 7.7 mm ± 0.21 and 7.6 mm ± 0.17, respectively). Diameter increased significantly from initial measurements to measurements at 1 and 6 weeks (2-D, 8.8 mm ± 0.24 and 9.4 mm ± 0.15, both P < .001; 3-D, 8.7 mm ± 0.27 and 9.4 mm ± 0.11, both P < .001). Validation measurements showed no significant differences between 2-D or 3-D US and gold standard. There were no statistically significant associations between stent expansion and clinical parameters (sex, P = .78; age, P = .82; etiology/grade of cirrhosis, P = .99; indication for TIPS, P = .78, liver stiffness, P = .70). CONCLUSIONS: Underdilated self-expanding stent grafts used for TIPS creation significantly expand within first 6 weeks after intervention. These changes can be noninvasively monitored using 3-D US.
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