Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2019; 11(2): 217-225
Published online Feb 27, 2019. doi: 10.4254/wjh.v11.i2.217
Parallel transjugular intrahepatic portosystemic shunt with Viatorr® stents for primary TIPS insufficiency: Case series and review of literature
Driss Raissi, Qian Yu, Michael Nisiewicz, Steven Krohmer
Driss Raissi, Qian Yu, Michael Nisiewicz, Steven Krohmer, Department of Radiology, University of Kentucky, Lexington, KY 40536, United States
Author contributions: Raissi D designed the literature review, drafted and revised the manuscript and selected images; Yu Q performed research, drafted manuscript and created the table; Nisiewicz M performed research and drafted manuscript; Krohmer S reviewed and guided the manuscript.
Informed consent statement: Informed consent was obtained from each patient.
Conflict-of-interest statement: All authors state no conflict of interest.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Driss Raissi, MD, Assistant Professor of Radiology, Medicine and Obstetrics & Gynecology. Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY 40536, United States.
Telephone: +1-859-3231004 Fax: +1-859-2574884
Received: August 31, 2018
Peer-review started: August 31, 2018
First decision: October 16, 2018
Revised: December 31, 2018
Accepted: January 9, 2019
Article in press: January 9, 2019
Published online: February 27, 2019

Transjugular intrahepatic portosystemic shunts (TIPS) can alleviate complications of portal hypertension such as ascites and variceal bleeding by decreasing the portosystemic gradient. In limited clinical situations, parallel TIPS may be only solution to alleviate either variceal bleeding or ascites secondary to portal hypertension when the primary TIPS fails to do so. Data specifically addressing the use of this partially polytetrafluoroethylene covered nitinol stent (Viatorr®) is largely lacking despite Viatorr® being the current gold standard for modern TIPS placement.


All three patients had portal hypertension and already had a primary Viatorr® TIPS placed previously. All patients have undergone failed endoscopy to manage acute variceal bleeding before referral for a parallel stent (PS). PS were placed in patients presenting with recurrent variceal bleeding despite existence of a widely patent primary TIPS. Primary stent patency was verified with either Doppler ultrasound or intra-procedural TIPS stent venography. Doppler ultrasound follow-up imaging demonstrated complete patency of both primary and parallel TIPS. All three patients did well on clinical follow-up of up to six months and no major complications were recorded. A review of existing literature on the role of PS in the management of portal hypertension complications is discussed. There are three case reports of use of primary and PS Viatorr® stents placement, only one of which is in a patient with gastrointestinal variceal bleeding despite a patent primary Viatorr® TIPS.


Viatorr® PS placement in the management of variceal hemorrhage is feasible with promising short term patency and clinical follow-up data.

Keywords: Transjugular intrahepatic portosystemic shunt, Parallel stent, Portal hypertension, Varices, Viatorr®, Tandem, Double barrel, Case report

Core tip: To our knowledge, we are first to report a three-case series with 6-month follow-up data using Viatorr® for both primary transjugular intrahepatic portosystemic shunt (TIPS) and parallel TIPS placement for the management of recurrent upper gastrointestinal variceal hemorrhage. Although, parallel TIPS placement has been previously reported, it was largely using bare metal stents and/or fully covered stents. Data regarding the use of the partially polytetrafluoroethylene-covered nitinol stent (Viatorr®) in parallel TIPS placement is largely lacking despite this device being the current gold standard for TIPS placement.