lCLINICAL INVESTIGATION l Percutaneous Inferior Vena Cava–to–Portal Vein Shunt (PIPS) Using a Stent-Graft: Preliminary Results

l l Purpose: To present preliminary results of an inferior vena cava (IVC)–to–portal vein shunt (PIPS) that is created through the caudate lobe of the liver. Methods: Sixteen patients (13 men; mean age 50 years, range 32–63) were referred for PIPS procedures because of bleeding varices (n 5 11), intractable ascites (n 5 4), and hepatorenal syndrome (n 5 1). The severity of liver disease was Child’s B in 2 and Child’s C in 14. The PIPS was created by a transhepatic puncture through the IVC and the portal vein; an endograft made of polytetrafluoroethylene sutured to a Palmaz stent was placed through a jugular approach. Results: In 13 (81%) patients, the portal vein–to–IVC tracts were successfully created. The postprocedural portal vein–IVC gradients varied from 1 to 9 mm Hg (mean 5). There were 2 deaths in the 30-day periprocedural period from adult respiratory distress syndrome and hepatorenal syndrome. A third patient died at 31 days from liver failure owing to continu-ing alcohol abuse. In addition, there was 1 case of peritoneal bleeding treated with blood product replacement. The follow-up period ranged from 14 to 671 days (mean 343). None of the patients treated for variceal bleeding had another bleeding episode, but 2 patients who had a PIPS procedure for refractory ascites did not benefit from the procedure. Postprocedure, 46% (6/13) of the patients had hepatic encephalopathy, which was unchanged from baseline. The primary and secondary patency rates at 365 days were 60 % and 65%, respectively. Conclusions: The preliminary results using a stent-graft to create an IVC–portal vein shunt are encouraging and support further work to better determine the role of this procedure. J Endovasc Ther 2002;9:503–510 Key words: portal hypertension, portacaval shunts, portosystemic shunt, Palmaz stents, polytetrafluoroethylen